Methods and apparatus for rehabilitation and training

ABSTRACT

A method of rehabilitation using an actuator type that includes a movement mechanism capable of applying a force that interacts with a motion of a patient&#39;s limb in a volume of at least 30 cm in diameter, in at least three degrees of freedom of motion of the actuator and capable of preventing substantial motion in any point in any direction in said volume, in which a same movement mechanism is used at two different places of rehabilitation.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/305,178 filed on Jun. 16, 2014, which is a continuation of U.S.patent application Ser. No. 10/597,633 filed on Jul. 6, 2007, which is aNational Phase of PCT Patent Application No. PCT/IL2005/000142 havingInternational Filing Date of Feb. 4, 2005, which claims the benefit ofpriority under 119(e) of U.S. Provisional Patent Application Nos.60/633,442, 60/633,428 and 60/633,429 all filed on Dec. 7, 2004,60/604,615 filed on Aug. 25, 2004, 60/566,079 and 60/566,078 both filedon Apr. 29, 2004, and 60/542,022 filed on Feb. 5, 2004, the contents ofthe above applications are all incorporated by reference as if fully setforth herein in their entirety.

This application is also related to PCT applications, PCT/IL2005/000138entitled “Gait Rehabilitation Methods and Apparatuses”;PCT/IL2005/000137 entitled “Rehabilitation with Music”;PCT/IL2005/000135 entitled “Neuromuscular Stimulation”;PCT/IL2005/000139 entitled “Fine Motor Control Rehabilitation”;PCT/IL2005/000140 entitled “Methods and Apparatuses for RehabilitationExercise and Training”; and PCT/IL2005/000141 entitled “Methods andApparatus for Rehabilitation and Training”; all filed on Feb. 4, 2005.The disclosures of all these applications are incorporated herein byreference.

FIELD OF THE INVENTION

The present invention relates to manipulation of a body, for example forphysical rehabilitation and/or training.

BACKGROUND OF THE INVENTION

After accidents or strokes, persons often need a prolongedrehabilitation process in an attempt to recapture some or all of thebody function damaged in the accident or stroke. Such rehabilitation mayinclude one or both of two elements, a physical rehabilitation portion,in which damaged or unused muscles, nerves and/or joints are broughtback to full functioning (to the extent possible) and a cognitiverehabilitation portion, in which the cognitive ability to control thebody is restored. In some cases, the damage to the body and/or brain issuch that a patient needs to be trained in modified functionality (e.g.,when one limb is made short) or even new functionality, for example, inthe use of an artificial limb.

Physical therapy is currently provided mainly by personal attention of aphysical therapist who monitors and instructs a patient in theperformance of certain exercises. Thus, costs for rehabilitation arehigh and compliance after a patient leaves a treatment center isrelatively low.

Some home physical therapy devices are known, for example a productcalled “backlife” provides CPM (Continuous Passive Motion) of the spine.

U.S. Pat. No. 5,836,304, the disclosure of which is incorporated hereinby reference, describes a cognitive rehabilitation utilizing a remotetherapist.

U.S. Pat. No. 5,466,213, the disclosure of which is incorporated hereinby reference, describes a rehabilitation system using a robotic arm.

An article in Journal of Rehabilitation Research and Development, Vol.37 No. 6, November/December 2000, titled “Development of robots forrehabilitation therapy: The Palo Alto VA/Stanford experience”, byCharles G. Burgar, M D; Peter S. Lum, PhD; Peggy C. Shor, O T R; H. F.Machiel Van der Loos, PhD, the disclosure of which is incorporatedherein by reference, describes usage of robots for rehabilitation.

SUMMARY OF THE INVENTION

A broad aspect of some embodiments of the invention relates torehabilitation methods and apparatus suitable for a wide range ofsituations, including, temporal, mental, cognitive, motor, locationand/or other situations.

An aspect of some embodiments of the invention relates to arehabilitation device which guides a patient to perform a motion with acorrect spatial trajectory, by the device applying one or more pushing,assisting, reminding, responding and/or resisting forces during a motion(or intent to move) by the patient. In an exemplary embodiment of theinvention, the forces are applied by an actuator, for example, a roboticarticulated arm or a spherically jointed lever. In some embodiments, theapplied forces act as a force field, optionally continuous, whichimpedes and/or guides a patient. Alternatively or additionally tospatial trajectories, orientation trajectories and/or speed trajectoriesare guided, supported and/or measured.

In an exemplary embodiment of the invention, the device supports, for agiven volume of space and a range of force strengths, substantially any3D trajectory within that volume. In an exemplary embodiment of theinvention, a device is provided which supports the range of motion of ahealthy arm or leg in one, two or three dimensions. In some cases, apartial volume is sufficient, for example, 50% or 30% of such a volume.

Optionally, the device is programmable with various trajectories (pathsand/or velocities) and/or forces. Optionally, the forces at one point inthe trajectory can vary responsive to an actual trajectory by thepatient, possibly a same trajectory (e.g., at an earlier point thereof)and/or responsive to a rehabilitation plan and/or improvement of thepatient. Optionally, the device learns the patient motion and repeats itwith a correction (e.g. a smoothing of trajectory and or speed).Alternatively or additionally, the device can learn a motion entered bya physiotherapist and replay it for the patient, with an optionaladjustment (e.g. a limb size adjustment).

In an exemplary embodiment of the invention, the trajectories and/orforces are defined for one or more points on the body, on same and/ordifferent limb or body part. Optionally, a point is controlled (and/ormeasured) with 3, 4, 5 or 6 degrees of freedom.

In an exemplary embodiment of the invention, the programming comprisesprogramming an electronic controller. In an exemplary embodiment of theinvention, the programming comprises mechanical programming.

An aspect of some embodiments of the invention relates to arehabilitation device adapted for home use. In an exemplary embodimentof the invention, the device is portable in a home, for example, notpermanently attached to any surface and/or including wheels. In anexemplary embodiment of the invention, the device is collapsible on aregular basis. In an exemplary embodiment of the invention, the deviceis light enough to avoid structural overloading of residential floors,for example the device can weigh less than 100 kg, less than 50 Kg orless than 25 Kg. Optionally, the device can be folded down to fit in atrunk of a standard sedan-type car, for example having a maximumdimension of less than 120 cm. Optionally, the device breaks down intoparts which are light enough to be carried by a non-handicapped person.

In an exemplary embodiment of the invention, the device ensures that apatient is correctly positioned. Optionally, the patient is notified tocorrect his position. In an alternative embodiment of the invention, thedevice recalibrates itself to take the patient position into account.

In an exemplary embodiment of the invention, a device is usable (e.g.,by programming, attachments and/or setting) for a plurality of differenttreatments, for example, a plurality of different body sizes, aplurality of different ages, a plurality of different joints and/or aplurality of different appendages.

In an exemplary embodiment of the invention, a rehabilitation device isprovided which is portable for various activities, for example, indoorsand/or outdoors, such as, cooking, barbequing and eating at a table.

An aspect of some embodiments of the invention relates to rehabilitationof daily activities, for example, eating, pouring tea, knocking nailsand cooking. In an exemplary embodiment of the invention, a kitincluding position sensors and/or other sensors is provided to attach todaily objects and track their use and provide feedback and/orinstructions for rehabilitation. Optionally, such feedback and/orguidance are provided mechanically by a rehabilitation robot. In anexemplary embodiment of the invention, a daily activities trainingpedestal includes one or more adjustable work spaces on which dailyactivities is carried out, for example one surface emulating a table andanother emulating a saucer (e.g., for training of tea pouring.

An aspect of some embodiments of the invention relates to long termrehabilitation and/or training. In an exemplary embodiment of theinvention, a rehabilitation device is used for a long period of time,for example, months or years. Optionally, a same device is used both forrehabilitation and for training of a patient in correct motions. In anexemplary embodiment of the invention, a rehabilitation device is usedfor preventive training, for example, ensuring that a patient withdeveloping arthritis does not start favoring a diseased joint.Optionally, a rehabilitation device is used to achieve a specificrehabilitation goal, such as rehabilitation of a particular limb.Optionally, the device is used for non-medical training, for example asa universal gym machine.

An aspect of some embodiments of the invention relates to support and/ormeasurement of various mental states of a patient, for example,motivation, depression, endurance, ability to train in pain, abilityand/or desire to communicate and/or work and/or interact with others.These states often overlap. For example, depression is often expressedas lack of motivation. In an exemplary embodiment of the invention,motivation is estimated by comparing performance in diagnosis, gameand/or therapy situations. Such comparing optionally includes analyzingif a person achieved a same performance under different motivationalstates and/or how often did the person strain his limits. In anexemplary embodiment of the invention, the motivational state is usedfor one or more of estimating progress, suggesting psychologicaltreatment, controlling difficulty of exercise and/or providingmotivational incentives automatically.

An aspect of some embodiments of the invention relates to support and/orovercoming of cognitive problems while performing physicalrehabilitation. In an exemplary embodiment of the invention, cognitiveand/or perceptive limitations are overcome by providing one or more ofinstructions, feedback and guidance in a plurality of modalities, inless damaged modalities (e.g., selecting from various possibilities),and/or with a degree of enhancement congruent with the limitation (e.g.,larger letters for weak eyesight). In an exemplary embodiment of theinvention, the degree of enhancement is changed over time, as part of arehabilitation of the limited function.

An aspect of some embodiments of the invention relates to multi-modalrehabilitation. In an exemplary embodiment of the invention, multiplebody systems (e.g., motor, visual, auditory, visual-motor), skillsand/or senses are rehabilitated using a same system, for example, motorcontrol, motor propreception, visual perception and sound generation. Inan exemplary embodiment of the invention, coordination between suchsystems is trained. In one example, hand-eye coordination isrehabilitated. In another example, hand-leg coordination isrehabilitated. In an exemplary embodiment of the invention, paths ofcoordination which are damaged are targeted for rehabilitation.

An aspect of some embodiments of the invention relates to feedback forrehabilitation. In an exemplary embodiment of the invention, thefeedback includes feedback on carrying out of daily activities.Alternatively or additionally, the feedback includes feedback from aremote therapist or automatic feedback, during an activity.Alternatively or additionally, the feedback includes on a quality of themotion carried out by the patient.

An aspect of some embodiments of the invention relates to rehabilitationtreatment methods. In an exemplary embodiment of the invention, trainingspecifically in daily activities is carried out with the assistance of arehabilitation device. Alternatively or additionally, training toprevent deterioration is provided, for example, to prevent deteriorationof Parkinson's disease caused by neglecting of arm/function.Alternatively or additionally, training to provide long term improvementis carried out, for example, to provide improvement in cerebral palsy.Alternatively or additionally, treatment to prevent disease is carriedout, for example, training a patient to not neglect a joint just becauseit hurts.

An aspect of some embodiments of the invention relates to using arehabilitation device for both rehabilitation and testing, diagnosingand/or monitoring. In an exemplary embodiment of the invention, thedevice is used to assess the abilities of a patient and then torehabilitate that patient. Alternatively or additionally, the device isused to measure the patient and calibrate future rehabilitation to thosemeasurements. Exemplary measurements include size, strength, range ofmotion and motion quality, mental state and/or cognitive and/orperceptive abilities.

An aspect of some embodiments of the invention relates to arehabilitation method related to motion quality. In an exemplaryembodiment of the invention, a quality of a motion is defined.Optionally, when a patient is being rehabilitated, automated feedback isprovided to the patient regarding the quality of his motion.Alternatively or additionally, part of rehabilitation and/or training isteaching a patient the quality value for various motions.

An aspect of some embodiments of the invention relates to correctness ofmotion. In an exemplary embodiment of the invention, a rehabilitationdevice is programmed with a correct movement. In an exemplary embodimentof the invention, a correct motion is programmed into the device byperforming the correct motion and then storing the motion in adevice-associated memory. Optionally, the motion is programmed in duringa dedicated teaching mode or when the device is off-line. Alternatively,the device learns during usage by a patient.

Optionally, the device is used to teach a patient what correct motionis, for example using template and/or using rules (e.g., a ⅔ power rulefor motor control). In an exemplary embodiment of the invention,correctness of motion is evaluated as a parameter of rehabilitation andfeedback is provided thereon.

An aspect of some embodiments of the invention relates to arehabilitation device for daily activities, in which the rehabilitationdevice is configured to train and/or test patients in the carrying outof daily activities. In an exemplary embodiment of the invention, therehabilitation device can be used in proximity to real-life settings,such as a table or a counter.

An aspect of some embodiments of the invention relates to positioning ofa rehabilitation device including a motion mechanism. In an exemplaryembodiment of the invention, a motion mechanism has a limited range ofmotion and/or accuracy. The rehabilitation device is optionallypositioned to make maximum usage of this range of motion, e.g., bymatching to a specific exercise. In an exemplary embodiment of theinvention, the rehabilitation device includes a positioning element, forexample a rail and/or one or more joints that can be used to fix themotion mechanism at a desired position and/or orientation. Optionally,the positioning element is motorized, for example, to allow automatic ornon-manual motion of the motion mechanism.

An aspect of some embodiments of the invention relates to arehabilitation method in which a healthy body part is used forrehabilitating a diseased body part. In an exemplary embodiment of theinvention, a rehabilitation device allows simultaneous or parallelmotion of two limbs, one damaged and one not, and uses the correctmotion of an undamaged limb as a basis for force field definition forthe damaged limb. Alternatively or additionally, sequential motion byundamaged and then damaged limbs is provided. Optionally, the undamagedmotion is modified, for example reduced in force, speed or range ofmotion. Optionally, the motion is mirror motion or synchronized motion(e.g., arm and leg during swimming). In an exemplary embodiment of theinvention, a device which can hold two limbs is used. In someembodiments the motion of the two limbs is linked. In other embodiments,there is some or complete de-coupling between the limbs, at least inreal time.

An aspect of some embodiments of the invention relates to a multi-pointrehabilitation device in which the rehabilitation device is attached toa human body at multiple points which can move relative to each other,which motion is part of rehabilitation.

In an exemplary embodiment of the invention, the rehabilitation deviceattaches to two limbs, for example an arm and a leg or two arms.

In an exemplary embodiment of the invention, the rehabilitation deviceseparately allows motion in 3D space of two bones on either side of ajoint.

In an exemplary embodiment of the invention, the device mechanicallylimits motion for one or more of the points. Optionally, one or more ofthe points are tracked (in one or more dimensions) but their motion isnot mechanically limited in some or any directions.

In an exemplary embodiment of the invention, the rehabilitation devicesupports complex motion in which different parts of the body are calledupon to carry out certain motions, for example, shoulder motion andwrist motion.

An aspect of some embodiments of the invention relates to a mechanicalstructure for a rehabilitation device. In an exemplary embodiment of theinvention, the device comprises an arm mounted on a joint, with a bodyattachment point, for attachment to or holding by a patient, mounted onthe arm. The joint acts as a spherical joint, allowing movement of thearm along substantially any path on the surface of a sphere, within arange of angles, for example, ±90 degrees relative to the center of thejoint, in either of phi and theta directions (e.g., in sphericalcoordinates). Optionally, the center of rotation for such motions issubstantially a same center of rotation for all the paths. In anexemplary embodiment of the invention, the joint and/or the arm as awhole lack singularity points in the range of motion. Optionally, theresistance to motion of the joint (the device may add resistance) issubstantially uniform, substantially independently of the sphericalmotion.

In an exemplary embodiment of the invention, the spherical jointcomprises a ball in socket joint, with the arm attached to the ball orto the socket. The other one of the ball or socket is optionallyattached to a base, for example, a base which stands on a floor or isattached to a wall or a ceiling.

In an exemplary embodiment of the invention, balancing is provided. Inone example, the device includes a weight attached to said ball oppositeof said arm and serving to balance the motion of said arm. Optionally,the motion of the arm is substantially balanced over the entire range ofmotion thereof. In an exemplary embodiment of the invention, thebalancing includes prevention of a resting torque. Alternatively oradditionally, balancing includes correction for an existing moment ofinertia or an expected moment of inertia during use. Optionally, thedevice is configured to include a resting force which tends to stabilizeor destabilize the device, depending on the embodiment.

Optionally, one or more guiding plates are provided. In an exemplaryembodiment of the invention, a pin attached to the ball, optionally partof the weight, is constrained to travel within a slot (e.g., a rectangleor other shape) defined in a guide plate. Optionally, the slot iselastic.

Optionally, one or more motors are provided to rotate the ball and/orapply force in a desired direction.

Optionally, one or more directional brakes are provided to selectivelystop motion of the ball in a desired direction.

Optionally, one or more uni-directional brakes are provided toselectively stop motion of the ball in any direction.

In an alternatively embodiment of the invention, two or more jointshaving a shared center of rotation, are provided instead of a ball, forexample a universal joint.

In an exemplary embodiment of the invention, the arm is extendible alongits axis. Optionally, a motor is provided for selectively moving orapply force to resist motion of the extension along the axis.Optionally, one or more brakes are provided to selectively resist motionof said extension along said axis.

In an exemplary embodiment of the invention, the extension is balanced,so that it has no self motion. Alternatively or additionally, theextension, even when extended to various extents does not affect abalance of said arm.

Optionally, a rehabilitation device is positionable at variousorientations. Optionally, the device includes a joint between its baseand an articulating portion thereof.

An aspect of some embodiments of the invention relates to a ball jointwith selective locking. In an exemplary embodiment of the invention, achuck is provided to selectively lock rotation of the ball joint.Optionally, a plurality of directional brakes are provided. Optionally,one or more sensors generates an indication of a direction of forceapplication and a controller selects which directional and/oruni-directional brakes to release responsive to the force direction.

An aspect of some embodiments of the invention relates to a telescopingelement, optionally used as part of a rehabilitation device. In anexemplary embodiment of the invention, at least three portions areprovided, two ends and a center, with extension or retraction forcesbeing applied to the central portion. The central portion is attached tothe two end portions using a rack and pinion (one rack on each endportion and the two pinions at either end of the central portion. A beltinterconnects the two pinions so that they move in concert.

An aspect of some embodiments of the invention relates to aforce-feedback control mechanism including a spring. Changes incompliance are provided by changing an effective length of the spring.In an exemplary embodiment of the invention, the spring is a flat spiralspring and the compliance is in a direction perpendicular to the planeof the spring.

An aspect of some embodiments of the invention relates to a forcecontrol mechanism for a human-movable element. In an exemplaryembodiment of the invention, a spring is provided to counteract forceapplied by a human. Optionally, the degree of force is adjustable,optionally by preloading the spring (or other resilient element).Optionally, the human movable element is also moved by a motor and saidcompliance is optionally provided to said human motion. Optionally adamping element, for example viscous cushioning, is provided.

In an exemplary embodiment of the invention, the resilient element isconfigurable, optionally on the fly, to provide a desired degree ofresistance to the movement. Optionally, the resilient means isre-adjusted to follow actual motion of the element.

In an exemplary embodiment of the invention, the motor moves the handleusing one joint and a second joint is used for the force compliance.

In an exemplary embodiment of the invention, the force compliance isprovided by one resilient element to a plurality of axes simultaneously,substantially without coupling between the axes.

In an exemplary embodiment of the invention, movement of the element inspherical rotation axially compresses a resilient element which thenprovides compliance.

In an exemplary embodiment of the invention, power is provided to theelement using a gear system which cannot be back-driven. Whenback-driving is detected, it is mechanically shunted to a resilientelement, which provides compliance.

In an exemplary embodiment of the invention, a mechanical diode designis provided in which a motion is imparted to a lever using a gear and inwhich the lever cannot move the gear. In an exemplary embodiment of theinvention, the diode comprises a gear or lever engaging a worm gear witha low enough lead angle (i.e., not back driven) a motor turns the wormgear, thereby moving the gear and/or a lever attached thereto. Due tothe low lead angle, when the gear rotates, the worm gear moves axiallyrather than rotates. Optionally, the worm gear sits on springs oranother elastic element which provide a degree of resiliency to motionof the gear. Optionally, the springs are pre-stressed to a desiredamount. Optionally, the worm gear is rotated to follow motion of thelever and maintain a desired tension and/or symmetry in the elasticelement(s).

An aspect of some embodiments of the invention relates to a manualmanipulator which moves or controls movement of a human body using atleast one wire and optionally one or more robotic elements, so thatmotion in 3D of at least one point of the body is constrained by themanipulator. In an exemplary embodiment of the invention, themanipulator is configured for use as a rehabilitation device.Optionally, one or more motors are provided to move the at least onepoint. Optionally, one or more resilient elements are provided to allowsome slack with resiliency to be provided in one or more wires.Optionally, three wires are provided to constrain 3D motion.

An aspect of some embodiments of the invention relates to patientpositioning in a rehabilitation system. In an exemplary embodiment ofthe invention, the system determines patient position using an imagingsystem. In an exemplary embodiment of the invention, alternatively oradditionally, a location of a chair or other support for the patient,relative to the system, is determined. Optionally, a spring-loaded wiresystem is used to measure the relative positions. Optionally, a pressuresensitive mat is used.

In an exemplary embodiment of the invention, the patient is instructedto perform one or more motions and the relative positions are determinedfrom the trajectories of the motions. Optionally, position is determinedin 2D, rather than in 3D. Alternatively, 3D position and/or orientationinformation is determined.

In an exemplary embodiment of the invention, a moving part of the systemitself or a light pointer portion of the system are used to mark and/ornote a correct positioning.

In an exemplary embodiment of the invention, once the relative positionis determined, one or more exercises are modified to take into accountthe relative positions.

An aspect of some embodiments of the invention relates to safety of arehabilitation device. In an exemplary embodiment of the invention, therehabilitation device includes one or more mechanical fuses whichselectively tear when shear, strain and/or torque on a replaceableelement (such as a pin) increase above a threshold. Alternatively to amechanical pin, an adjustable magnetic pin may be used, in which twoparts of a pin attach to each other based on magnetic attraction. Theattraction level is optionally set by moving a magnet inside one of theparts of the pin. Torque is optionally detected by providing a serratedconnection between the pin parts which links relative rotation of thepin parts and separation of the parts. Optionally, a wire is provided inthe pin so that tearing of the wire can be detected by the deviceelectrically.

In an exemplary embodiment of the invention, a dead-man switch isprovided for a patient in which if a patient lets go of the switch, thedevice stops or goes into a predefined or dynamically determined safemode and/or position. Optionally, the dead-man switch is on a wirelesselement held by a good limb or body part, for example, being stepped on,held by hand or held in a mouth.

In an exemplary embodiment of the invention, a voice activated shut-offis provided, for example to allow a patient to stop the rehabilitationby shouting.

In an exemplary embodiment of the invention, the rehabilitation deviceanalyses motions and/or forces applied by the patient, to detectproblems. For example, any gross irregularities will cause therehabilitation device to stop.

In an exemplary embodiment of the invention, the device includes atleast one moving element which includes resiliency when moving so thatthere is slack, with increasing resistance as amount of slack usedincreases. Optionally, the slack serves to allow a user to not perform amotion according to the movement of the element, while providingsufficient time to detect that the motion is incorrect and that appliedforces are reaching a safety limit.

Examples of types of situations where embodiments of the invention maybe useful, follow. In some exemplary embodiments of the invention, arange of treatment lengths are supported, including for example, goaloriented treatment, short term treatment, long term treatment and/orpreventive activities. In some exemplary embodiments of the invention,treatment over multiple stages in rehabilitation, possibly an entirerehabilitation process, are supported, in some cases with a same device.In some exemplary embodiments of the invention, multiple body parts maybe rehabilitated, either simultaneously or separately, in some cases,with a same device. In some embodiments of the invention, multiplemodalities are rehabilitated, either together or using a same device,for example, motor control, motor feedback, vision, audio ability and/orspeech. A range of complexities and hierarchies of motion are supportedby some embodiments, for example, simple motion of one joint and complexplanning of multi-limb motion. Multiple treatment locations aresupported by some embodiments of the invention, for example, ICU, bed,clinic, home and/or outdoor. Multiple activity types are supported insome embodiments of the invention, for example, dedicated rehabilitationexercises, training exercises, daily activities, outdoor activitiesand/or diagnosis activities. In some embodiments of the invention,multiple body positions are supported, for example, lying down, standingand/or sitting. In some embodiments of the invention, a range of mental,cognitive and/or motor ability states are supported. It should be notedthat not all the embodiments of the invention support all the variousranges and the extents of the ranges described above.

There is thus provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation using an actuator type thatincludes a movement mechanism capable of applying a force that interactswith a motion of a patient's limb in a volume of at least 30 cm indiameter, in at least three degrees of freedom of motion of the actuatorand capable of preventing substantial motion in any point in anydirection in said volume, comprising:

exercising a patient at a first place of rehabilitation selected from abed, a wheel-chair, a clinic and a home, using an actuator of saidactuator type which interacts with a motion of said patient; and secondexercising said patient at a second place of rehabilitation selectedfrom a bed, a wheel-chair, a clinic and a home using a second actuatorof said actuator type which interacts with a motion of said patient;

wherein said first exercising and said second exercising utilize a samemovement mechanism design for moving the actuators.

Optionally, said first and said second exercising are performed using asame rehabilitation apparatus.

In an exemplary embodiment of the invention, said motion mechanism ismotorized. Optionally, said motion and said force are controlled by acontroller. Alternatively or additionally, said motion mechanism iscapable of applying a force of at least 10 Kg to a tip of said actuator.Alternatively or additionally, said motion mechanism is capable ofapplying a force of different magnitudes in different directions ofmotion said actuator.

In an exemplary embodiment of the invention, said motion mechanism isadapted to apply selective resistance to motion of said actuator.

In an exemplary embodiment of the invention, said actuator is adapted tointeract with said motion in a plurality of modes including at leastcausing said motion, guiding said motion and recoding said motion.Optionally, said first and said second exercising use different motioninteraction modes.

In an exemplary embodiment of the invention, at least one of said firstand said second exercising are performed in water.

In an exemplary embodiment of the invention, said first and said secondexercising are performed on a same limb.

In an exemplary embodiment of the invention, said first and said secondexercising are different exercises.

In an exemplary embodiment of the invention, the method compriseskeeping track of progress of said patient including said first and saidsecond exercising, in a same controller coupled with said secondactuator.

Optionally, said actuator is rigid.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation using an actuator that includes amovement mechanism capable of applying a force that interacts with amotion of a patient's limb in a volume of at least 30 cm in diameter, inat least three degrees of freedom of motion of the actuator and capableof preventing substantial motion in any point in any direction in saidvolume, comprising:

exercising a first organ type of a patient using said actuator; and

exercising a second organ type of the patient using said actuator.

In an exemplary embodiment of the invention, the method comprisesreplacing an attachment to said patient of said rehabilitation devicebetween said exercising. In an exemplary embodiment of the invention,the actuator comprises a controller which controls said interaction.Optionally, said controller is programmed with a plurality of differentexercises for different limbs

In an exemplary embodiment of the invention, the method comprisesadjusting at least one of a spatial position and orientation of saidactuator relative to said patient, between said exercises.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation kit, comprising:

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter, in at least three degrees of freedom of motionof the actuator and capable of preventing substantial motion in anypoint in any direction in said volume;

a tip on said actuator; and

a plurality of attachments modularly exchangeable for said tip, at leasttwo of which are adapted to fit different organs.

Optionally, at least one of said attachments is powered via saidactuator. Alternatively or additionally, at least one of saidattachments is capable of rotation in three axes of rotations.

There is also provided in accordance with an exemplary embodiment of theinvention a device for rehabilitation, comprising:

a motorized actuator adapted to support a movement by a person by atleast one of resisting motion, guiding motion and causing motion; and

a controller configured to control said actuator,

wherein, said controller is programmed to provide rehabilitationexercising for patient's switchable between a plurality of modes inwhich one or more or motivation, cognitive ability and motor ability iseither high or low.

Optionally, said controller is configured to provide instructions in aselectable one of at least three information presentation modes andcomplexity levels.

Alternatively or additionally, said controller is configured to providesupport for motor activity of said patient in a selectable one of atleast three levels of assistance.

Alternatively or additionally, said controller is configured to provideincentive feedback to said patient in a selectable one of at least threelevels of incentive.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation using an actuator that includes amovement mechanism capable of applying a force that interacts with amotion of a patient's limb in a volume of at least 30 cm in diameter, inat least three degrees of freedom of motion of the actuator and capableof preventing substantial motion in any point in any direction in saidvolume, comprising:

coupling said actuator to a person in a home setting;

performing a daily activity by said person, wherein said actuatorinteracts with said activity to enhance rehabilitation.

Optionally, said daily activity is outdoors

Alternatively or additionally, said actuator interacts using a storedrehabilitation plan.

Alternatively or additionally, said actuator reports to a remotelocation on a progress of rehabilitation.

Alternatively or additionally, said actuator prevents unsafe motions bysaid patient.

Alternatively or additionally, the method comprises first practicingsaid daily activity at a rehabilitation clinic.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation, comprising:

rehabilitating a first patient on a first rehabilitation device;

rehabilitating a second patient on a second rehabilitation device; and

passing information regarding rehabilitation between said two devices,said information including at least one of a score, current progress,spatial position of a portion of the patient and a game play.

Optionally, said patients play a game together using said devices forinput and output. Optionally, said patients play against each other.Alternatively or additionally, said first rehabilitation device providesa different support fro said first patient than said second devicesupplies for said second patient, to compensate for differences inability between the two patients.

In an exemplary embodiment of the invention, said information is passedin real-time.

In an exemplary embodiment of the invention, said information is passedusing a wireless connection.

In an exemplary embodiment of the invention, the method comprisesmonitoring said first and said second patients by a remote therapist.

In an exemplary embodiment of the invention, the method comprisesremotely connecting into a therapy group by said patients.

In an exemplary embodiment of the invention, said two devices are in asame room.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation system configuration, comprising:

A first rehabilitation device; and

A second rehabilitation device linked by a wireless data link with saidfirst rehabilitation device such that the two rehabilitation devices canact in synchrony.

There is also provided in accordance with an exemplary embodiment of theinvention a method of cooperative rehabilitation, comprising:

providing a first actuator that includes a movement mechanism capable ofapplying a force that interacts with a motion of a patient's limb in avolume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the actuator and capable of preventing substantialmotion in any point in any direction in said volume;

providing a second actuator that includes a movement mechanism capableof applying a force that interacts with a motion of a patient's limb ina volume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the actuator and capable of preventing substantialmotion in any point in any direction in said volume;

engaging said first and said second actuators by a patient and by anon-therapist, respectively; and

rehabilitating said patient using said first actuator and saidnon-therapist.

Optionally, said non-therapist is a blood relative.

In an exemplary embodiment of the invention, the method comprisesguiding said non-therapist and said patient by instructions by acontroller.

In an exemplary embodiment of the invention, said non-therapist is underan age of 18.

In an exemplary embodiment of the invention, said non-therapist is underan age of 10.

In an exemplary embodiment of the invention, said providing is at a homeof said non-therapist.

In an exemplary embodiment of the invention, said non-therapist hasfewer than 50 hours experience in physical therapy.

In an exemplary embodiment of the invention, said non-therapist hasfewer than 10 hours experience in physical therapy.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device comprising:

a frame;

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter, in at least three degrees of freedom of motionof the actuator and capable of preventing substantial motion in anypoint in any direction in said volume;

a joint interconnecting said frame and said actuator and allowingmultiple different relative placements of said movement mechanism onsaid frame, such that said volume moves relative to said frame.

Optionally, said motion mechanism has different motion limitations indifferent spatial direction and wherein said multiple relativeplacements include changing an orientation of said mechanism.

In an exemplary embodiment of the invention, said joint comprises alinear joint.

In an exemplary embodiment of the invention, said joint comprises aswiveling joint.

In an exemplary embodiment of the invention, said frame is curved.

In an exemplary embodiment of the invention, said joint is motorized.

In an exemplary embodiment of the invention, the device comprises acontroller that controls said joint according to an exercise stored insaid controller to be performed.

In an exemplary embodiment of the invention, the device comprises atleast one sensor that reports a position of said joint.

There is also provided in accordance with an exemplary embodiment of theinvention a method of setting up a rehabilitation system including anactuator that includes a movement mechanism capable of applying a forcethat interacts with a motion of a patient's limb in a volume of at least30 cm in diameter, in at least three degrees of freedom of motion of theactuator and capable of preventing substantial motion in any point inany direction in said volume, comprising:

determining a rehabilitation exercise to be performed;

selecting a desired position for said motion control mechanism for saidexercise; and

adjusting a position of the mechanism on a frame according to saiddesired position.

In an exemplary embodiment of the invention, the method comprisesautomatically adjusting said position.

In an exemplary embodiment of the invention, the method comprisesautomatically reporting to a user said desired position.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

a joint having freedom of motion in Phi (rotation) and Theta (elevation)spherical angles, said freedom allowing positioning of said joint insubstantially any angular position within a range of at least 30 degreesin each angular direction.

a substantially rigid radial extension attached to said joint andadapted for movement with a limb of a person at at least one pointthereof; and

a controller adapted to control motion of said joint and thereby motionof said radial extension.

In an exemplary embodiment of the invention, said radial extension isbalanced such that said point remains stable if no force is applied andmoves if force is applied by said person. Optionally, said balancing canbe varied to match a weight of an attachment selectively attached tosaid extension. Alternatively or additionally, said balancing can bevaried by said controller along a path of motion to match a change inmoment on said point. Alternatively or additionally, said balancing canbe set to provide a neutral buoyancy to said limb.

In an exemplary embodiment of the invention, said joint is a ball joint.

In an exemplary embodiment of the invention, said joint comprises twoorthogonal hinges with a common center of rotation.

In an exemplary embodiment of the invention, said controller comprises amechanical controller.

In an exemplary embodiment of the invention, said controller comprisesan electrical controller.

In an exemplary embodiment of the invention, the device comprises atleast one brake adapted to selectively resist said freedom motion.Optionally, said brake is continuously controlled by said controller.Alternatively or additionally, said brake is uni-directional in only oneof said Phi and Theta directions. Alternatively or additionally, saidbrake is operative in both said Phi and said Theta directions.

In an exemplary embodiment of the invention, the device comprises atleast one motor adapted to move said joint. Optionally, said motor isadapted to apply at least 10 Kg of force at said point. Alternatively oradditionally, said motor is continuously controlled by said controller.Alternatively or additionally, said motor cannot be back-driven by saidextension.

In an exemplary embodiment of the invention, the device comprises atleast one resilient element adapted to provide resilient compliance whensaid person moves said point in a trajectory other than a trajectory forwhich motion is controlled to move by said controller. Optionally, saidcontroller sets a degree of said resilient compliance.

In an exemplary embodiment of the invention, said element is extendible.

In an exemplary embodiment of the invention, element includes a conduitfor electrical power.

In an exemplary embodiment of the invention, the device comprises atleast one position sensor which reports on a angular position of saidjoint.

In an exemplary embodiment of the invention, the device comprises atleast one force sensor which reports on a force applied to said joint.

In an exemplary embodiment of the invention, said controller isconfigured to control said motion and provide at least one of assistingmotion by said patient limb, resisting motion by said patient limb,guiding motion by said patient limb, nudging said patient limb to moveand moving said patient limb.

In an exemplary embodiment of the invention, said controllers storesthereon a plurality of different rehabilitation exercises.

There is also provided in accordance with an exemplary embodiment of theinvention a balanced rehabilitation device, comprising

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter, in at least three degrees of freedom of motionof the actuator and capable of preventing substantial motion in anypoint in any direction in said volume; and

at least one weight that balances said actuator such that no force isrequired to maintain said actuator in space.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation, comprising:

assisting motion in space of a patient along a trajectory, using anactuator;

providing resistance to motion by said patient away from saidtrajectory, said resistance including compliance in a direction awayfrom said trajectory,

wherein said compliance is achieved mechanically without anelectro-mechanical feedback loop.

In an exemplary embodiment of the invention, said compliance is providedby braking.

In an exemplary embodiment of the invention, said compliance is providedby at least one resilient element.

In an exemplary embodiment of the invention, the method comprisestracking said motion of the patient with said compliance.

In an exemplary embodiment of the invention, a different force ofresistance is provided at different points in space along the motion.

In an exemplary embodiment of the invention, a different force ofresistance is provided at different direction at a same point in space.

In an exemplary embodiment of the invention, said compliance is at least1 cm.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device comprising:

a lever adapted to move together with a portion of a patient's body;

a motor, operatively connected to said lever in a manner which preventsback-driving of the motor by said lever, said motor being operative tomove the lever; and

a spring coupled to said lever and providing resilience to said motion.

In an exemplary embodiment of the invention, said spring provides saidresilience only when said lever is moved different from motion caused bythe motor.

In an exemplary embodiment of the invention, attempted back-driving ofsaid motor applies force to said spring.

In an exemplary embodiment of the invention, said spring has acontrollable pre-load.

In an exemplary embodiment of the invention, the device comprises adamping element in parallel with said spring.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device comprising:

a lever adapted to move together with a portion of a patient's body;

a motor, operatively connected to said lever to move the lever;

a slot guiding motion of said lever; and

a spring coupled to said lever and providing resilience to said motion.

In an exemplary embodiment of the invention, said spring is mounted onsaid slot.

There is also provided in accordance with an exemplary embodiment of theinvention a multi-axis resilient element for rehabilitation, comprising:

a first set of at least one joint adapted to allow motion in sphericalcoordinates of a radially extending lever;

a second set of at least one joint adapted to allow motion in sphericalcoordinates of said first set;

a resilient element having a compression associated with motion of saidlever thereby compliance to motion in said second set.

In an exemplary embodiment of the invention, said resilient element hasa settable pre-load.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device comprising:

a lever adapted to move together with a portion of a patient's body;

a motor, operatively connected to said lever to move the lever; and

a spring coupled to said lever and providing resilience to said motion,wherein said spring has a settable compliance.

In an exemplary embodiment of the invention, said compliance is set by acontroller. Optionally, said setting is continuous.

In an exemplary embodiment of the invention, said spring is a flatspring having a settable effective length.

There is also provided in accordance with an exemplary embodiment of theinvention a telescoping mechanism comprising:

at least three telescoping sections, including a central section and twoend sections;

an actuating mechanism that extends said central section;

a first rack and pinion mechanism that couples motion of one of saidends and of said central portion;

a second rack and pinion mechanism that couples motion of the other oneof said ends and of said central portion; and

a belt operatively linking the two rack and pinion mechanisms.

There is also provided in accordance with an exemplary embodiment of theinvention a portable rehabilitation device comprising:

a base for stabilization of the device to a surface or object; and

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter, in at least three degrees of freedom of motionof the actuator and capable of preventing substantial motion in anypoint in any direction in said volume,

wherein said device has two configurations:

-   -   a first configuration suitable for practicing rehabilitation;        and    -   a second configuration suitable for storage, and wherein

said device is adapted to pass between said configurations manually, bya layman.

In an exemplary embodiment of the invention, said device is taken apartfor said second configuration.

In an exemplary embodiment of the invention, said device comprises atleast one quick-connection.

In an exemplary embodiment of the invention, said device folds down.

In an exemplary embodiment of the invention, said device folds flat tofit in a car trunk.

In an exemplary embodiment of the invention, said device weighs lessthan 30 Kg.

In an exemplary embodiment of the invention, said device is wheeled

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

a lever adapted to move together with a portion of a patient's body;

at least one motor coupled to said lever adapted to interact with amotion of said lever; and

at least one separable element interconnecting said motor and said leverand adapted to decouple at least a portion of said lever from said motoris a predetermined force on the element is exceeded.

In an exemplary embodiment of the invention, said element comprises atearing pin.

In an exemplary embodiment of the invention, said element comprises aseparable joint.

In an exemplary embodiment of the invention, said element is connectedbetween a body of said lever and an attachment mounted on said lever.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

a lever adapted to move together with a portion of a patient's body;

at least one motor coupled to said lever adapted to interact with amotion of said lever;

at least one resilient element interconnecting said motor and saidportion; and

a controller adapted to identify a safety problem and stop said motorupon said identifying, said resilient element preventing such stoppingfrom being immediate.

In an exemplary embodiment of the invention, said device comprises anactuator that includes a movement mechanism capable of applying a forceto said lever which lever interacts with a motion of a patient's limb ina volume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the lever.

In an exemplary embodiment of the invention, said controller identifiessaid safety problem by detecting a shout by said patient.

In an exemplary embodiment of the invention, said controller identifiessaid safety problem by calculating at least one position of a point ofthe body of said patient and comparing the result of the calculation toone or more allowed value.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation docking station comprising:

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter, in at least three degrees of freedom of motionof the actuator and capable of preventing substantial motion in anypoint in any direction in said volume;

at least one actuator adapted to assist in rehabilitation by; and

a docking port adapted for locking to a patient carrier.

In an exemplary embodiment of the invention, said port is adapted toengage a wheelchair.

In an exemplary embodiment of the invention, said port is adapted toengage a bed.

In an exemplary embodiment of the invention, said station is mobile.

In an exemplary embodiment of the invention, said station includes atleast one port for attachment of a second actuator thereto.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation comprising:

providing an actuator that includes a movement mechanism capable ofapplying a force that interacts with a motion of a patient's limb in avolume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the actuator and capable of preventing substantialmotion in any point in any direction in said volume;

coupling said actuator to a point on a human body;

applying a force vector to said point by said actuator, said forceincluding a rotation.

In an exemplary embodiment of the invention, said force vector includesat least two rotations directions relative to the force vector.

In an exemplary embodiment of the invention, the method comprisesapplying a second force to at least a second point on said body,simultaneously with said force.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation comprising:

providing a first actuator that includes a movement mechanism capable ofapplying a force that interacts with a motion of a patient's limb in avolume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the actuator and capable of preventing substantialmotion in any point in any direction in said volume;

coupling said first actuator to a first point on a human body;

providing a second actuator that includes a movement mechanism capableof applying a force that interacts with a motion of a patient's limb ina volume of at least 30 cm in diameter, in at least three degrees offreedom of motion of the actuator and capable of preventing substantialmotion in any point in any direction in said volume;

coupling said second actuator to a second point on a human body; and

applying different forces to said points using said actuators.

In an exemplary embodiment of the invention, said first actuator appliesa rotation.

In an exemplary embodiment of the invention, said different points areon a same limb.

In an exemplary embodiment of the invention, said different points areon different limbs. In an exemplary embodiment of the invention, themethod comprises exercising the two limbs in concert. Alternatively oradditionally, the method comprises copying motion from one limb to theother limb.

There is also provided in accordance with an exemplary embodiment of theinvention a method of reverse kinematics, comprising:

controlling motion of at least one point on an organ using an actuatorthat includes a movement mechanism capable of applying a force thatinteracts with a motion of a patient's limb in a volume of at least 30cm in diameter, in at least three degrees of freedom of motion of theactuator and capable of preventing substantial motion in any point inany direction in said volume;

controlling a position of at least a second point on the organ; and

reconstructing by a computer of a value of a bending of at least onejoint of said organ from said motion and said position.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

an actuator that includes a movement mechanism capable of applying aforce that interacts with a motion of a patient's limb in a volume of atleast 30 cm in diameter;

a support for a patient; and

a controller adapted to adjust a rehabilitation exercise according tothe relative positions of said actuator and at least one of said patientand said support.

In an exemplary embodiment of the invention, the device comprises adistance sensor for determining said relative positions.

In an exemplary embodiment of the invention, the device comprises animaging sensor for determining said relative positions.

In an exemplary embodiment of the invention, said controller relates tothe relative placement of said patient and said actuator.

In an exemplary embodiment of the invention, said controller assumes therelative positions differ only in two dimensions.

In an exemplary embodiment of the invention, the device comprises apointer which indicates a desired patient placement.

In an exemplary embodiment of the invention, said controller isconfigured to use said actuator to determine said relative placement.

In an exemplary embodiment of the invention, said controller isconfigured to use said actuator to indicate a desired relativeplacement.

In an exemplary embodiment of the invention, said controller isconfigured to adjust said exercise on the fly, during an exercisesession and in response to patient movement.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

a memory storing therein a correspondence between exercises and paymentcodes;

a controller adapted to control a rehabilitating exercise and generate areport including a code from said memory corresponding to said exercise.

There is also provided in accordance with an exemplary embodiment of theinvention a rehabilitation device, comprising:

at least one actuator adapted to support motion of a body part;

at least one sensor associated with the actuator and measuring saidmotion; and

a controller which analyses said measured motion and generates a measureof quality of motion and which modifies a rehabilitation plan responsiveto said quality of motion measure.

In an exemplary embodiment of the invention, the controller modifies aselection of future exercises according to a measured quality of motion.

In an exemplary embodiment of the invention, the controller modifies aselection of parameters for future exercises according to a measuredquality of motion.

In an exemplary embodiment of the invention, the quality of motionmeasure used is defined as the degree of matching to a ⅔ power law.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation, comprising:

causing a person to carry out at least one exercise;

estimating a mental state of said person from a result of said at leastone exercise; and

automatically selecting at least one second exercise according to saidestimation.

In an exemplary embodiment of the invention, estimating a mental stepcomprises comparing performance between two exercises, one or which isexpected to elicit a higher compliance.

In an exemplary embodiment of the invention, estimating a mental stepcomprises comparing performance within an exercise, using the maximumability of the patient as a base line against which variation can bedetermined.

In an exemplary embodiment of the invention, said estimating isautomatic.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation, comprising:

determining a patient's ability to perform a motor task;

determining a patient's ability to perform a non-motor task; and

automatically selecting an exercise or parameters of an exercise for thepatient according to said determinations.

In an exemplary embodiment of the invention, said selecting comprisesmatching an instruction or feedback modality to a perceptive ability.

In an exemplary embodiment of the invention, said selecting comprisesmatching an instruction or feedback modality to a cognitive ability.

In an exemplary embodiment of the invention, said selecting comprises anexercise or series of exercises designed to rehabilitate both of saidmotor and said non-motor abilities.

In an exemplary embodiment of the invention, said exercise rehabilitatesvisual-motor coordination.

There is also provided in accordance with an exemplary embodiment of theinvention a method of rehabilitation comprising;

moving a motorized actuator having a tip to a spatial position within avolume having a diameter of at least 30 cm; and

instructing a patient to apply force against said tip, wherein saidactuator provides a compliant resistance to said force. Optionally, themethod comprises selecting the resistance according to the spatiallocation.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Non-limiting embodiments of the invention will be described withreference to the following description of exemplary embodiments, inconjunction with the figures. The figures are generally not shown toscale and any sizes are only meant to be exemplary and not necessarilylimiting. In the figures, identical structures, elements or parts thatappear in more than one figure are preferably labeled with a same orsimilar number in all the figures in which they appear, in which:

FIG. 1 is a schematic showing of an articulated-arm based rehabilitationdevice, in accordance with an exemplary embodiment of the invention;

FIG. 2 is a schematic block diagram of a remote rehabilitation system,in accordance with an exemplary embodiment of the invention;

FIG. 3A illustrates a force field generated by a rehabilitation devicein accordance with an exemplary embodiment of the invention;

FIG. 3B shows an exemplary profile of a force of resistance;

FIG. 4A is a flowchart of a method of using a rehabilitation device, inaccordance with an exemplary embodiment of the invention;

FIG. 4B is a flowchart of a long term use of a rehabilitation device, inaccordance with an exemplary embodiment of the invention;

FIG. 5 illustrates a system including limb position sensing, inaccordance with an exemplary embodiment of the invention;

FIG. 6 illustrates an elbow holding attachment, in accordance with anexemplary embodiment of the invention;

FIGS. 7 and 8 illustrate two hand rehabilitation devices, in accordancewith exemplary embodiments of the invention;

FIGS. 9A and 9B illustrate devices for controlled motion of more thanone point in a body, in accordance with exemplary embodiments of theinvention;

FIG. 10 shows a ball-based rehabilitation device, in accordance with anexemplary embodiment of the invention;

FIG. 11 shows a balancing of the rehabilitation device of FIG. 10, inaccordance with an exemplary embodiment of the invention;

FIG. 12 illustrates a drive system for a plate-based rehabilitationdevice, in accordance with an exemplary embodiment of the invention;

FIG. 13A illustrates a coupling device for a plate drive system, inaccordance with an exemplary embodiment of the invention;

FIG. 13B illustrates a plate with a flexible slot, in accordance with anexemplary embodiment of the invention;

FIG. 14A illustrates a two plate rehabilitation device, in accordancewith an exemplary embodiment of the invention;

FIGS. 14B and 14C illustrate guide plates in accordance with exemplaryembodiments of the invention;

FIG. 15A shows a wrist attachment, which provides control and/orfeedback for one or more degrees of motion of a hand, in accordance withan exemplary embodiment of the invention;

FIGS. 15B-15F show various attachments according to exemplaryembodiments of the invention;

FIGS. 16A-16D illustrate various methods of elbow support in accordancewith exemplary embodiments of the invention;

FIG. 17A illustrates a rehabilitation device with varying orientation,in accordance with an exemplary embodiment of the invention;

FIGS. 17B and 17C show an alternative rehabilitation device with varyingorientation, in accordance with an exemplary embodiment of theinvention;

FIG. 17D shows an alternative rehabilitation device with varyingorientation, in accordance with an exemplary embodiment of theinvention;

FIG. 18 shows a rehabilitation device for an arm and a leg, inaccordance with an exemplary embodiment of the invention;

FIG. 19A shows a rehabilitation device for two sides of a body, inaccordance with an exemplary embodiment of the invention;

FIG. 19B shows a docking station, in accordance with an exemplaryembodiment of the invention;

FIG. 19C shows an occupied docking station of the type shown in FIG.19B;

FIG. 19D shows mobile rehabilitation devices positioned near a bed, inaccordance with an exemplary embodiment of the invention;

FIG. 19E shows an alternative mobile rehabilitation device, coupled to abed, in accordance with an exemplary embodiment of the invention;

FIG. 19F exemplifies the use of mobile rehabilitation devices in abathtub, in accordance with an exemplary embodiment of the invention;

FIG. 19G shows a rehabilitation device configured for use for dailyactivities, in accordance with an exemplary embodiment of the invention;

FIG. 19H shows a device for assisting in training for activities ofdaily living, in accordance with an exemplary embodiment of theinvention;

FIG. 20 shows a chuck mechanism in accordance with an exemplaryembodiment of the invention;

FIG. 21 shows an alternative non-ball, balanced, rehabilitation device,in accordance with an exemplary embodiment of the invention;

FIG. 22A shows another alternative non-ball rehabilitation devicemechanism, in accordance with an exemplary embodiment of the invention;

FIG. 22B shows force control mechanisms and brakes attached to thedevice of FIG. 22A;

FIG. 23 shows a cantilevered rehabilitation device mechanism, inaccordance with an exemplary embodiment of the invention;

FIG. 24A is a side cross-sectional view of a force control mechanism asused in FIG. 22B, in accordance with an exemplary embodiment of theinvention;

FIG. 24B is a flowchart of the operation of the mechanism of FIG. 24A,in accordance with an exemplary embodiment of the invention;

FIG. 25 shows a force control mechanism in accordance with analternative embodiment of the invention;

FIG. 26A shows a Z-axis extension mechanism in accordance with anexemplary embodiment of the invention; and

FIG. 26B shows a force control mechanism for an attachment, exemplifiedas part of FIG. 26A, in accordance with an exemplary embodiment of theinvention.

DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION General

The methods and apparatus of some embodiments of the invention providefor controlled, partially controlled or directed motion of portions ofthe body. The following sections describe this equipment by firstdescribing the design of an exemplary device (an articulated arm),followed by various rehabilitation methods and then additionalrehabilitation device designs and uses. The invention should not beconsidered as being limited to particular devices used to illustrateparticular methods. Rather, many of the methods can be practiced with avariety of devices and many of the devices can be used to practice avariety of methods.

Articulated Arm Design

FIG. 1 is a schematic showing of an articulated-arm based rehabilitationdevice 100, in accordance with an exemplary embodiment of the invention.In some of the description device 100 is referred to even though otherdevices described herein would suit just as well. The term “system” isused in some places instead of referring directly to device 100 and mayalso include multiple devices and monitors.

Device 100 comprises an articulated arm 102 that projects upwards out ofa table or other pedestal 104. A tip 108 of arm 102 serves as acontrolled point which can travel various 3D trajectories. Optionally,pedestal 104 is not attached to a floor but is instead weighted by anoptionally weighted base 106 (which may be located elsewhere thanshown), to prevent tipping or capsizing of device 100 during use.Optionally, base 106 includes electronics used to power the arm.Alternatively or additionally, weight 106 is a temporary weight, forexample a water-filled bladder. Other exemplary general layouts areshown below.

In an exemplary embodiment of the invention, arm 102 is an articulatedarm, which supports movement in 3D space. Alternative designs, forexample based on a single joint and an extending arm, are describedbelow.

In an exemplary embodiment of the invention, arm 102 comprises aplurality of sections 110 interconnected by a plurality of joints 112.In an exemplary embodiment of the invention, each joint is motorized,for example as known in the art of robotic arms. Alternatively oradditionally, each joint is selectively lockable, for example asdescribed below. Optionally, angular position sensors are provided ateach joint and/or a position sensor at tip 108, so the position in spaceof arm 102 and/or of tip 108 can be determined. The joints may be jointswith one, two, three or more degrees of freedom.

In an exemplary embodiment of the invention, arm 102 (e.g., its lockingand/or force application and/or movement) is controlled by a controller114, for example a personal computer or a dedicated embedded computer.Optionally, a display 116 and/or a user input device 118 are used forinteraction with a user. Optionally, display 116 comprises (or islimited to) an audio display, for example for providing audible and/orspeech instruction and/or feedback.

An external connection 120 for connection to a remote computer and/orother units, is optionally provided, for example for use as described inFIG. 2 below.

It should be noted that some implementations of device 100 include nocomputer. Some implementations require no electrical power. In oneexample, a mechanical computer is used to control the device parameters.In some embodiments of the invention, resistance to motion (optionallyvariable) is provided using a brake system.

Arm Specification

As will be described below in greater detail, various rehabilitationmethods in accordance with exemplary embodiments of the inventionrequire different types of motion and/or responsiveness from arm 102 orother devices as described below. In some embodiments of the inventionthe use of device 100 for rehabilitation places certain constraints ondevice 100, with respect to, for example, smoothness of motion,responsiveness, coupling between axes, balancing and/or supported rangeof motion.

For example, some types of rehabilitation in accordance with exemplaryembodiments of the invention require a patient to move tip 108 along atrajectory. Resistance may be predefined along the trajectory orpossibly no resistance at all is provided. In any case, it may bedesirable that device 100 not adversely affect motions by the patient,at least if they are correct. In a particular example, tip 108 providesno resistance to motion along a certain trajectory and strongly resistsmotion not along the certain trajectory. Such a tip is termed a neutraldirected motion tip.

In order to support generalized 3D trajectories in a neutral manner(e.g., not providing resistance at least along the trajectory ofmotion), arm 102 is optionally required to not have singularity pointsin a predefined and useful range of motion, for example a sphere ofradius of 0.8 meters or less, for example, 0.5 meters or less. The term“singularity” is used to define a point and arm position where moving toan adjacent point passes the limits of one or more joints and requires arelatively large change in joints position, which is generally timeconsuming and is exhibited to a patient as a sudden resistance or delay.In addition, providing neutral motion means that a uniform (anddesirably zero) resistance can be provided at any point in a desiredrange of motion. Possibly more important in some embodiments of theinvention is that any changes in resistance be smoothly varying. In someembodiments, arm 102 provides a counter-force or even provides motion.Uniformity and controllability of such force is required in someembodiments of the invention. In some embodiments, tip 108 is configuredto support a limb of a patient, so that the limb feels buoyant.

The magnitude of force that arm 102 can apply and/or resist depend onthe rehabilitation methods with which it is to be used. For example, onerehabilitation type will require arm 102 to resist absolutely anincorrect motion, up to a force of, for example, 100 Kg applied at tip108. In another example, it is sufficient that arm 102 resists motion upto a force level at which it is certain that the patient feels theresistance, for example, 1 Kg. A reminding force may be useful in someembodiments, for example, 10 Kg, which may ensure that a patient doesnot inadvertently move tip 108 against the force.

In an exemplary embodiment of the invention, the range of motion of tip108 covers a volume of 50×50×50 cm. In other embodiments, a smaller orlarger volume is provided. The volume need not be rectangular.Optionally, the volume also includes rotation of tip 108 around one, twoor three axes. In some embodiments, the volume of movement of the tip isone or two dimensional (i.e., in a plane or along a line).

In some embodiments of the invention arm 102 is expected to respond to apatient's activity in a manner which will seem natural or at least notinterfere with the rehabilitation motion. In an exemplary embodiment ofthe invention, the responsiveness of arm 102 is faster than 10 ms orbetter than 5 ms.

A general property of many mechanical systems is that due tomanufacturing tolerances, sensing tolerances, design and/ornon-optimality of the construction some uncontrollable freedom of motionis available. In an exemplary embodiment of the invention, the amount ofuncontrolled motion in device 100 is less than 5 mm or less than 2 mm.In some embodiments of the invention, a spring-loaded mechanism is usedto prevent unrestrained backlash motion.

Robotic technology for achieving such ranges of motion andresponsiveness and forces are well known, albeit possibly at a highcost. Various additional suitable technologies are described below.Optionally, controller 114 controls arm 102 in a passive, active or aresponsive manner to achieve these objectives. In an exemplaryembodiment of the invention, such active control of arm 102 results incompensation for at least 80% or more of the moment of inertia of arm102. It should be noted that different values may be required fordifferent situations, for example a greater or lesser responsiveness ora greater or lesser uncontrollable freedom.

Arm 102 is, for example, 1 meter, 0.8 meters, 0.5 meters, 0.3 meters orany greater smaller or intermediate length.

Motion Types

In device 100 as illustrated, the motion which is controlled is that ofa single point, i.e., tip 108. By providing various attachments for tip108, tip 108 may be connected, for example to a bone, to a joint or to adifferent part of the body. The attachment may be rigid, for exampleusing a strap or it may depend on cooperation of or action by thepatient, for example, as a handle or a rest. Specific attachmentdevices, for example for a hand, arm, elbow, knee, ankle and/or shouldermay be provided. Further, as described below, multiple tips 108(optionally with individual arms 102) may be provided for attachment atdifferent points of the body, on a same or different body part.

When providing rehabilitation various types of motion may be supported,for example, one or more of:

a) Passive motion. Tip 108 is moved (by device 100) and the patientmoves with it.

b) Resisted motion. The patient moves tip 108 and encounters resistance.The resistance may be of various magnitudes and may be uniform in alldirection or be directional.

c) Assisted motion. When a patient moves tip 108, a positive feedback onarm 102 increases the force of motion in the direction moved by thepatient.

d) Force field motion. The patient moves tip 108. Along a certaintrajectory one level of resistance (or none) is encountered. Deviationfrom the trajectory is not allowed or meets with resistance. FIG. 3Ashows an example of such a force field. Motion along a “correct”trajectory 302 can be without resistance, or possibly assisted. Anincreased resistance is exhibited in a volume 304 surrounding trajectory302. An even greater resistance is exhibited in a surrounding volume306. A prevention of motion may be provided in an outside volume 308. Inan exemplary embodiment of the invention, a corrective force vector 310is applied when not on trajectory 302, pointing towards trajectory 302.Optionally, instead of a corrective force, resistance varies as afunction of distance from trajectory 302, thus, motion of tip 108 isnaturally urged back to trajectory 302. FIG. 3B is a graph showing anexemplary relationship between divergence from a path and applied force.Optionally, the force is applied in the direction of the path.Alternatively, the force maybe a unidirectional force of resistance.

This type of motion may be used to help train the patient in a desiredmotion.

e) Mirrored motion. Motion of tip 108 is required to mirror thetrajectory of motion of a different element, for example for dual limbrehabilitation as described below.

f) Free motion. Patient moves tip 108 in any way he desires, possiblyreceiving feedback. As the patient (or therapist or helper) moves tip108, device 100, may record it for future playback. In a playback modethe prerecorded motion (or path) is optionally reconstructed using othermodes. Optionally, the recorded path is modified (e.g., smoothed orotherwise edited), for example automatically or manually.

g) General Force Field. A force field and/or an assistance field isdefined which is not related to any particular trajectory. For example,a range of trajectories may be allowed to be practiced by a user, or areal or virtual situation simulated (e.g., water, areas with obstacles).

h) Local force field. A force field which is applied to only a smalllocality and/or only in one or two dimensions.

i) Restricted motion. One or more points of the body of a subject aresupported or prevented from moving. Optionally, the angles between suchpoints and the moving points on the patient are measured. In one examplethe elbow is locked with a dedicated harness allowing only a shouldermotion. In some embodiments, the restriction is partial and/or isprovided by a movable element (e.g., an arm 102).

j) Initiated Motion. The patient initiates the motion (e.g., a 1 cmmotion or 100 gram force) and device 100 completes or helps the patientcomplete the motion in space. The completion may be of a wholetrajectory or of part of a trajectory.

k) Implied motion. Device 100 begins the motion and the patientcompletes it. Device 100 may assist the rest of the motion in variousmanners (e.g., by changing to one of the modes described herein afterthe motion starts). If the patient fails to pick up the motion, device100 may generate a cue, for example an audio reminder. Different partsof a single motion trajectory may each have a machine initiationdefinition. Optionally, if a patient is too slow in moving, device 100begins the motion.

l) Cued motion. The patient receives a cue from the system before motionaccording to a different mode starts. The cue can be, for example,vibration of tip 108, stimulation pads on the skin, audio or visual cue.In some embodiments of the invention, the strength of the cue and/or itstiming and/or other ongoing activities (e.g., a visual display and game)are used to help train the coordination between different modalities,for example, hand-eye coordination. A motion cue can be used to train akinesthetic sense.

m) Teach Mode. Device 100 is taught a motion. In one example, atherapist performs a motion and motion parameters at each point arerecorded and can then be used for an exercise. Another way of teachingthe system is to use a path that the therapist uses. The therapist mayuse a control to indicate a point to be taught or a continuous mode maybe defined by which an entire trajectory is learned. Optionally the pathand points are edited before replay. Optionally, the paths areabstracted, for example, by smoothing or identifying motion points,before playback.

Thus, in some embodiments of the invention, rehabilitation device 100can provide one or more of Isokinetic, Isotonic and Isostatic exercises.

It should be appreciated that a definition of a trajectory which tip 108is to follow can include speed parameters (e.g., trajectory of path,trajectory of velocity, trajectory of force). For example, a user may beassisted, or urged, or expected, to move tip 108 at a certain speed. Thespeed may be, for example, absolute, or relative (e.g., requiring auniform speed or the speed to match a non-uniform profile).

Optionally, an angular trajectory is defined, which places constraintson an angular orientation of tip 108. In some embodiments, theconstraint is one dimensional. In others it is two or three dimensional.

Speed, angles and spatial trajectories in a particular rehabilitationscenario may each belong to a different one of the above motion types.For example, spatial trajectory may be of a force field type, whilespeed trajectory is free or assisted. The type of trajectory and/or itsparameters may also vary along the trajectory, as a function of timeand/or as a function of previous performance. For example, a smallerassistance at a later part of a trajectory may be provided for a type ofmotion which was properly (or better than expected) executed in anearlier part of the trajectory.

Trajectories may be absolute, for example, defined as a function of aresting point or a different point on device 100. In other embodiments,the trajectories are purely relative, for example, requiring a patientto move an arm in a straight line, regardless of starting point. Inother embodiments, a trajectory is partially relative, in that oncemotion starts, this determines the shape of the rest of the trajectory,for example, a start of a trajectory indicating if a patient is standingor sitting, and thus what type of hand motion is expected.

In some embodiments, such as described below, where multiple points 108are defined, the motion types of each point may be of different types.In some embodiments, what is defined is a trajectory as a function oftwo or more points in space. For example, if two points are used todefine an elbow configuration (e.g., angle between bones), thetrajectory constraints may be defined on the motion of the elbow. Suchmotion may be relative in space (e.g., a comparison of the two points)and not absolute (e.g., compared to a device reference point). Inanother example, different limitations are provided for differentpoints, for example, angular limitations at one point and velocitylimitations of another.

It should be noted that in some embodiments of the invention a tensor ortensor field is provided, as each point in space can have associatedwith it a speed, a force and/or a rotation, all of which can be scalaror a vector.

In some embodiments of the invention, different modes are defined fordifferent parts of a trajectory or for different parts of space (e.g.,for a particular arm). Optionally, a mode may be triggered based on theactual performance. For example, if motion velocity is below a certainthreshold, a more assistive mode is provided. Similarly, a pause of overa threshold may imply a more assistive mode. An exact motion may imply aless assistive mode.

In an exemplary embodiment of the invention, modes may be changedautomatically, for example, when nearing a patient motor limit (e.g.,range of motion) or when nearing a cognitive limit (e.g., spatialneglecting zone or time neglect zone such as for long motions).

Exemplary Usage

FIG. 4A is a flowchart 400 of a method of using device 100, inaccordance with an exemplary embodiment of the invention.

At 402, device 100 is powered on (for electrical devices). Optionally,device 100 turns on when arm 102 is touched or moved a certain amount.Alternatively, motion of arm 102 may provide power for device 100.

At 404, if remote connection 120 is used, device 100 optionallydownloads instructions, for example what activities to suggest and/orwhat progress was expected and/or results from physical therapy at otherlocations. Optionally, a patient identifies himself to device 100, forexample, using a code, selecting a name form a list or using a smartcard or a magnetic card with user input 118. Optionally, rehabilitationinformation of a patient is stored or indexed on such a magnetic card orsmart card or on a portable flash memory device or portable hard disk.

At 406, an activity to be performed is selected. In a more automateddevice, the selection may be, for example automatic or by a patient froma displayed list of options. In a less automated device, for example, apatient may follow a chart provided to him by a rehabilitation center orby a guiding therapist.

At 408, arm 102 is optionally moved to a start position thereof, forexample by device 100 or by the patient (e.g., directly or by permittingdevice 100 to do so). It should be noted that in some trajectories nostart position is predefined. Instead, the actual starting position isused to define the rest of the trajectory.

In some embodiments of the invention, the position of the patientrelative to the system is indicated or measured (e.g. by vision system,by mechanical attachments) and the program is adjusted accordingly.

In some cases, device 100 is adjusted in another manner. For example, aparticular handle may be attached at tip 108, or legs of the device maybe raised or lowered. In a collapsible device (e.g., folding legs), thedevice may be set up. Optionally, such setting up is carried out beforeactivating device 100.

At 410, an optional warm-up session is carried out on the patient, toensure that he is ready for the activity. Optionally, one or morephysiological sensors, for example a muscle temperature sensor (e.g.,skin surface) are used to ensure (e.g., as a safety feature) that thepatient is sufficiently warmed up.

At 412, the patient is optionally tested to confirm an expected currentability.

At 414, the results of the test are optionally used to modify one ormore parameters of the selected activity or to select a differentactivity, for example, due to an under- or over-achievement of thepatient during testing. Exemplary modifications include: slowing downexpected speed, reducing expected or resistive force, reducing expectedor allowed range of motion and reducing number of repetitions.

At 416, the activity is carried out, for example, continuous passivemotion at 20 repetitions or motion (by patient) with resistance of 0.5Kg, along the entire trajectory. In another example, the resistancegrows as a function of speed, or if the speed is higher or lower than adefined speed trajectory, optionally using a mode or combination ofmodes as described above.

At 418, various measurements which are optionally made during theactivity, are optionally logged. Such logging may also be carried outconcurrently with the activity.

At 420, feedback may be provided based on the activity, for example, tothe patient, a rehabilitation expert and/or to device 100. Optionally,feedback is provided on a patient physiological condition as well, forexample, determining fatigue based on increased irregularities of motionand/or based on pulse rate or other physiological parameters.

At 422, a decision is optionally made to repeat an activity and/or toselect a new activity. Such a decision may be made, for example, basedon patient progress and/or fatigue.

In an exemplary embodiment of the invention, device 100 automaticallygenerates CPT codes or other reports used for billing. Alternatively, areport is generated which a human therapist approves and/or modifies. Insome embodiments of the invention the patient's progress is used toassess future expected payments and/or exercises and/or suggested humanguidance. Optionally, such future factors, patient improvement, timeelapsed and/or motivation of the patient in using and improving usingthe system, are used to decide on future financial support by a healthcare provider.

In an exemplary embodiment of the invention, if after a given time (e.g.several weeks) there is no improvement in function or other measurementsa decision can be made to stop the financial support. In another examplebased on documented improvement in certain areas (e.g. patient accuracy)the treatment support can be extended. In another example, the therapypayer may insist on minimum system usage (for example if a system wasdelivered to the patient home). By reviewing an on going usage report(possibly on line) the payer can decide to extend or stop usage.

In an exemplary embodiment of the invention, the system can simplygenerate codes and/or reports, for example using a look-up table (eachexercise can have an associated code) using table and also automaticallygenerate reports regarding other factors, such as motivation andcompletion of plan.

Planning and Long-Term Progress

FIG. 4B is a flowchart 430 of a long term use of device 100, inaccordance with an exemplary embodiment of the invention.

At 432, a new patient who is identified as needing rehabilitation istested, possibly using device 100. For example, such tests may includerange of motion tests, tests of maximum applied force at differentpoints in space, and/or tests of fineness of force control and motioncontrol. In an exemplary embodiment of the invention, device 100calculates limb size (or detects them using a camera) and uses the limbsize to adjust pre-stored exercises, for example to adjust theirtrajectories and/or starting point.

At 434, the results of the tests are analyzed to determine the needs ofthe patient and to formulate objectives of the rehabilitation. This actmay be, for example, manual, automated or manual with support fromdevice 100.

At 436, a rehabilitation plan is drawn up, including, for example one ormore of an expected progress chart, various allowed and/or requiredexercises and exercise parameters for different parts of the plan,definitions of increased and decreased difficulty levels for theexercises, allowed and/or required exercise sequences, number of cyclesfor each exercise, warm-up requirement, list of data to log, list ofpatient-modifiable information, one or more safety parameters whichshould not be passed and/or one or more parameter alert values at whichan alert should be provided to the patient and/or a rehabilitationexpect monitoring the patient's progress. It should be noted that whilegenerating a rehabilitation plan is a known activity, in an exemplaryembodiment of the invention, such a plan is special, for example, takinginto account one or more of the possibility of long term rehabilitation,the possibilities involved in having a device available at a home formultiple short sessions, the provision of multiple activities with asingle device, the needs of remote monitors and/or the programmabilityand responsiveness of a device in accordance with some embodiments ofthe invention. The plan may be generated manually, automatically ormanually with the assistance of device 100, for example an initial plangenerated automatically and then annotated or approved by a human.

At 438, the plan is carried out, while being monitored. In an exemplaryembodiment of the invention, the monitoring is manual. Alternatively, atleast some of the monitoring is automatic.

At 440, the plan may be modified in response to the monitoring, forexample, if slow progress is detected, the plan time frame may bechanged.

In some cases, as rehabilitation progresses, new problems may come up orbecome emphasized. In some cases, the plan may be modified (440). Inothers, testing may be repeated (442), generally to a lesser extent thanwhen the patient was initially evaluated.

In some plans, periodic testing (for example on device 100 at thepatient's home) is part of the plan. Such evaluative testing may also beused to determine when rehabilitation is complete.

At 444, rehabilitation is mostly completed and a training plan isoptionally made, for example to ensure maintenance of the rehabilitationor for other reasons (such as prevention of worsening or prevention oflimb or joint neglecting).

At 446, long term monitoring of the patient may be performed, forexample, testing the patient's abilities once a week or once a month.

At 448, new needs of the patient may be identified, for example based onthe monitoring or based on a periodic general test. In one example, apatient being rehabilitated for stroke may be determined after a time toneed rehabilitation for a progressing arthritic condition. In anexemplary embodiment of the invention, a personal profile is created fora patient. For example, such a profile may include a series of items towork on, for example smoothness of motion, which can be tackled one byone over time or if a certain threshold value is detected during testing(e.g., quality of motion went below a threshold).

As noted herein, a particular property of some embodiments of theinvention is that device 100 may be used over a wide range ofsituations, including long range treatment and following a patient frominitial rehabilitation through follow-up rehabilitation (e.g., tomaintain an ability) and diagnosis.

Scoring and Time Estimation

In an exemplary embodiment of the invention, the ability and/or progressof a patient are scored. In an exemplary embodiment of the invention,such scoring is used as an aid in deciding on the need and/or type offuture rehabilitation. Alternatively or additionally, scoring is used tomonitor the effect of rehabilitation exercises and/or help selectbetween exercises. Alternatively or additionally, scoring is used toensure that a patient's needs (e.g., personal rehabilitation needs orneed for balanced rehabilitation) are met. In an exemplary embodiment ofthe invention, scoring is used to identify areas where progress was madeand areas where additional therapy or modified therapy may be needed,due to lack of progress.

In an exemplary embodiment of the invention, one or more of thefollowing measures are used to score a patient's ability and/orprogress.

a) Motor scores may include one or more of Range of motion, time ofmotion, force, smoothness, lack of tremor, degree of tremor, spasticity,muscle tone, accuracy, quality of motion and/or force finesse (controlof force, e.g. not breaking an egg). These may be defined for a singlejoint or for a complex motion, for example for pinching between fingers,holding in a hand, moving of an arm. In addition some functional scoresmay be used to e.g.—the speed at which the patient can move a filledglass, and the ability to pick and place an object.

b) Cognitive scores may include one or more of coordination betweenmotion (motor skills) and senses (e.g., visual, auditory), speed ofreaction, % of successful task completion, quality of completion,mistakes, planning ability, level of instruction complexity used (e.glevel 1 is a simple visual & auditory instruction such as a forwardarrow on screen & audio verbal instruction, while level 5 is a complexscreen to motion interaction, such as following a 3D path as shown onscreen).

c) Mental stores may include one or more of: successful task completedat patient capabilities and/or pain envelope, measure of self work,amount of nudging required from the system, consistency of use (e.g., athome).

In an exemplary embodiment of the invention, scoring of the patient iscalibrated to other patients, for example, using a database of similarinjuries, or using scores of patients that are being rehabilitated at asame time. Alternatively or additionally, scoring is carried out betweena healthy and a non-healthy limb.

In an exemplary embodiment of the invention, scoring is used as an aidin diagnosis. In an exemplary embodiment of the invention, whendiagnosing a patient, scores are generated (e.g., by providing suitableexercises) for individual body part abilities and for general abilities.In an exemplary embodiment of the invention, device 100 can analyze apatient's abilities by generating experiments and then analyzing theresults. In one example, device 100 tests whether a patient will respondbetter to one type of exercise or to another by generating a series ofexercises including both types of exercises. The results of thepatient's performance are then analyzed to extract trends which indicatewhich of a controlled variable had a better or a desired effect on thepatient. Optionally, a human therapist selects the initial possibleexercises. Alternatively or additionally, a human therapist determineswhat percentage of time may be spent on such exercises. The scoringmethod or resolution may be adjusted by the therapist per the patientcondition for example, adjusting the accuracy of measurement or thedynamic range of the score or the expected results (e.g., forqualitative measures).

In an exemplary embodiment of the invention, a patient may show anincrease in a muscle strength score but not show a correspondingincrease in accuracy (correspondence may be, for example according to atable or according to a previous trend of the same patient, possiblywith a same limb). In such a case, the exercise plan for the patient maybe modified to include more accuracy-focused exercises and fewer musclebuilding exercises. It is noted that not all rehabilitation plans aimfor concurrent improvement in multiple measures. In some plans, onemeasure is focused on and once a desired improvement in that measure isachieved, a different measure is focused on.

In an exemplary embodiment of the invention, a score in progress is usedto estimate a time to reach a goal. Optionally, such estimation is basedon one or more of the following variables: motivation, innate abilityand current disability. Optionally, innate ability is estimated bytracking the progress. Optionally, a set of results and estimated timesfor different situations are stored in a database and used to generatean estimate. Optionally, a neural network is used. Motivation isoptionally estimated using methods as described below. Alternatively,manual estimation may be provided. Optionally, a time estimation alsoincludes thresholds of different scores which must be met. For example,an estimate may be conditioned on a certain motivation being maintained.Detection of a reduction in motivation may be used to prompt an updatein expected progress or suggest certain treatment.

Home Use

In an exemplary embodiment of the invention, device 100 is adapted forhome use. Such adaptation may include one or more of the followingfeatures:

a) Small size. For example, device 100 may take up less than 1 squaremeter of floor space. Optionally, device 100 is sized to fit throughstandard door ways (e.g., of width of 60 cm, 70 cm or 80 cm).

b) Simple interface. In an exemplary embodiment of the invention, device100 has a simple interface to a user, for example including a smallnumber of options to choose from, graphical and/or speech instructionsof use and/or feedback designed to be understand by a typical adult. Inan exemplary embodiment of the invention, a wired or wireless pendant orwrist-worn controller is used. For example, such a controller can have alimited set of commands, including, an exercise selector dial, a buttonfor selecting a dry-run or a slow version of the exercise, an activationbutton to start or stop an exercise, a scale or a pair of buttons toincrease or decrease exercise difficulty level, and a LED or LCD displayfor feedback (e.g., red LED for bad and green LED for good). In analternative embodiment, device 100 is voice activated and controlled,for example using an IVR (interactive voice response) type menu system.

c) Flexibility. In an exemplary embodiment of the invention, device 100is designed to be used by a range of different sized patients (orpersons living in a home) and for a range of different treatments, for aplurality of different body parts and/or appendages, for example, 1, 2,3 or 4 limbs or body parts or more. In some cases, various attachmentsmay be provided.

Optionally, device 100 is adapted for positioning at variousorientations and/or in proximity to home activities, such as at a tablefor rehabilitation of feeding and or activity of daily living.

d) Lack of fixation. In some embodiments of the invention, device 100 iseither simply fixed to a surface or not fixed at all, simplifyinginstallation and de-installation.

e) Mobility, detailed below.

f) Other home settings are optionally supported as well, for example,when the patient is in bed, in the living room and/or in a backyard.

In an exemplary embodiment of the invention, device 100 is connected tohome appliances such as a TV or HiFi system. In an exemplary embodimentof the invention, the patient can be instructed from the TV or the usercan play with the system using the TV as feedback. In another example, aset-top box is used as a local processor and/or a communication port toa remote station.

In an exemplary embodiment of the invention, use is made of the factthat device 100 is at home and conveniently located for the patient touse many times a day. In one example, rehabilitation activities aredesigned to cover a larger part of the day than is possible at aninstitute, for example, half or all of a day, while still allowing apatient to have a life with non-rehabilitation activities. For example,a rehabilitation plan can call for ten 5-minute sessions spread over anentire day, spaced by an hour.

In another example, device 100 interacts with real-life activitiesand/or using real-life objects, as described in more detail below. Inparticular, this allows a rehabilitation plan to show (and achieve) areal progress in the patient's ability to deal with real lifesituations, such as eating and getting dressed.

In an exemplary embodiment of the invention, devices in separate housesare interconnected, for example, within a family or between friends.Optionally, one of the participants may interact using a computer,rather than a device 100 (e.g., using mouse motions to emulate devicemanipulation, or as a player in a game using standard computerinterfaces).

In an exemplary embodiment of the invention, device 100 communicateswith an outpatient clinic so that home activities and clinic activitiesare synchronized. Optionally, the patient carries a memory unit (e.g., aUSB memory card) that includes his personal data.

In an exemplary embodiment of the invention, the home system generatesreminders to the patient to exercise, for example, audio reminders ore-mail or SMS reminders.

Remote Use

As noted above, device 100 is optionally used as part of a distributedsystem. FIG. 2 shows an exemplary distributed rehabilitation system 200.

One or more homes with rehabilitation devices 100 are shown. A network202, for example an Internet, a cable network, a cellular network or atelephone network, connect device 100 to a remote site. In an exemplaryembodiment of the invention, a remote site is a rehabilitation centerincluding a computer station 204 with a display 206 and a user input208. A single station 204 can monitor multiple devices 100, optionallyin real time. A plurality of stations 204 may be provided, at a same ordifferent sites. Optionally, a plurality of stations 204 are used tomonitor a single device 100. For example, each device 100 may have a lowlevel monitoring by a semi-skilled person, who shows difficult problemsto a skilled monitor who is in charge of or associated with manyunskilled monitored.

Also shown is an optional portable connection 212, for example using alaptop computer.

Also shown is an optional remote database 210, which may store data forone or more patients, for example, 100 or 1000 patients or more. Whilethe database may be at the rehabilitation site, this is not required. Insome cases the database is distributed, for example, amongrehabilitation sites and/or user devices 100.

In an exemplary embodiment of the invention, a group of patients arecollected into a network based on them having similar (or overlapping)aliments, treatment and/or prognosis and/or according to personalmatching. In an exemplary embodiment of the invention, the progress ofmembers of the group are presented to other members, possibly spurringcompetition. For patients with a lower motivation, a support group maybe provided, for example, one in which the patient is more advanced thanother members or one in which a group effort is being carried outinstead of a competition.

In one example of a group activity, each of a plurality of patients hasa role in a role playing game. The difficulty of each patient/role maybe set according to the patient's ability. A group leader may beselected. In another example, each player is required to copy themovements and/or instructions of the group leader. Optionally, eachplayer is protected from over-reaching his abilities by his device 100.

Other types of users may be supported in addition to monitors, forexample, a patient's general practitioner physician, or a family memberor caregiver may be able to log on and review a patient's progress.

Remote rehabilitation can follow several paths, for example, one or moreof:

a) Real-time monitoring. Optionally, a camera 214 is provided adjacentdevice 100 to allow a therapist to detect problems and/or give advice toa patient. Optionally, the data is analyzed by the therapist in realtime. Optionally, a real time reconstruction with animation software orVR (virtual reality) is used. Alternatively, off-line analysis isprovided. Different pay schedules may be provided for different types ofmonitoring. In addition, different rehabilitation needs may indicate thelevel of interaction between a remote therapist and a patient.Optionally, camera 214 is controllable by the therapist, for example tozoom and/or pan to certain parts of the patient. Optionally, the path ofthe camera is pre-planned to track planned or actual motion by thepatient and/or of various points on a body of the patient. Alternativelyor additionally to camera 214, real-time monitoring may be provided byvarious position and orientation sensors associated with device 100.This may also require only a reduced bandwidth as compared to visualmonitoring.

In an exemplary embodiment of the invention, a therapist can providereal-time feedback, for example using audio-visual methods and/or bycommanding device 100 to respond in a certain way, for example, toincrease force, to change a trajectory or to prevent a patient goingpast a safety limit.

b) Live start. A rehabilitation session is started live (e.g., oncamera) and once the therapist is convinced the patient can work on hisown, monitoring is stopped. Optionally, a patient can request help, forexample during an activity or between activities.

c) Planning. Plans including exercises and/or programming for device 100are provided by the remote site, for example, weekly, or at the start ofeach session. In some embodiments, planning is automatic and optionallyperformed with or without patient input at device 100.

d) Monitoring. A remote site can specialize in analyzing data uploadedto it from device 100 or another location and suggest changes. Othertypes of monitoring can also be practiced, for example, checking to seehow regularly a patient uses the system and/or for following complaints.A rehabilitation center may perform, for example, weekly checkups andpossibly require periodic testing. Optionally, a patient may be calledto come to the rehabilitation center, for example, for testing, teachingand/or additional therapy.

e) Testing. In an exemplary embodiment of the invention, a remote siteuses device 100 to administer tests to a patient and assess hiscondition and/or progress. In an exemplary embodiment of the invention,such testing is used to assess the efficacy of drugs and/or othertreatment prescribed for the patient. Optionally, periodic testing isused to select a most useful drug, for example, for a patient withParkinson's disease or for a spastic patient.

f) Home therapist. In some embodiments of the invention, a therapistwill come to the patient's home for a rehabilitation session. Forexample, the therapist can set up device 100, mark correct startingpositions, calibrate device 100 for the particular patient (e.g., size)and/or teach the patient the use of device 100. Optionally, thetherapist can access and/or be in contact with a remote site, forexample, for advice and/or monitoring of his work. When a therapistcomes for later sessions, the remote site may assist with comparingcurrent and past performance, for example. Optionally, a therapistbrings device 100 with him. Optionally, a therapist brings two devices.Optionally, a device brought by the therapist is used to control arehabilitation device already at the patient's home.

g) Remote maintenance. In an exemplary embodiment of the invention,device 100 can be maintained from a remote location, for example,including one or more of reporting by device 100 of technical problems;remote testing of mechanical abilities of device 100, with or withoutpatient assistance; remote testing of sensing abilities of device 100,with or without patient assistance; downloading and uploading logs;and/or downloading and uploading software. Optionally, device 100collects billing information which is remotely accessed. Optionally,device 100 collects usage information which may be used, for example, byan insurance company. In some embodiments, remote access to device 100is designed to maintain a patient's privacy, for example by hidingpatient identifying information, by limiting access to various logs andrecords and/or using password and other authentication schemes.

h) Remote motivation session. In an exemplary embodiment of theinvention, device 100 is used to detect a reduced motivation level and alive therapist (optionally provided at need) can provide liveencouragement and/or instruction. Live remote sessions in general may beprovided.

In an exemplary embodiment of the invention, virtual reality methods,for example goggle mounted displays are provided at the remote location,to help the remote operator feel in better control. Alternatively oradditionally, the operator can manipulate his viewpoint. In an exemplaryembodiment of the invention, various sensors (for example as describedbelow) are used to move a model of the patient, for remote and/or localfeedback.

Other Usage Scenarios

Device 100, in some embodiments thereof may be used in other ways thandescribed above. For example, in one embodiment of the invention asupervised group is provided, in which one or more therapistswatch/monitor/support a plurality of patients, each on a differentdevice. In such a supervised group, one or more of the followingscenarios may be acted out:

a) Bring along—a therapist brings a plurality of devices 100 to a civiccenter or old age home or the like, and teaches a session to a group ofusers.

b) Game—each patient plays a part in a game and a score is kept. In theexample of an adventure game (e.g., a role acting game), patients canearn life points, weapons, abilities and other items by improving theirabilities using rehabilitation exercises. The game may be personallyadapted to one or more patients, for example by providing assistance tothose patients who require it. In an exemplary embodiment of theinvention, the games require a patient to carry out certain physicalactivities. The activity may vary between patients according to theirneeds for rehabilitation. VR or simpler display technologies, such asscreens may be used to help patients become immersed in the game andfocus less on the other players. Such games can be played also when thepatients are distributed and interconnected by a network, such as theinternet.

c) Call-in group—the patients can join an existing group or game orsession, to form a virtual “therapy room”. Optionally, a chat line isprovided concurrent with the rehabilitation exercises. Optionally, arehabilitation server is provided for devices 100 to connect up to andregister requirements, obtain connections to other devices and/orcontrol access to a therapist.

In an exemplary embodiment of the invention, a group is supervised by atherapist and the therapist can monitor the group using a web cam, forexample. Alternatively or additionally, patient's exercises can bereconstructed on the therapists system using VR or simulation.Alternatively or additionally, the therapist can review data generatedby the system, such as scores. Optionally, different levels ofinteraction between the therapist and patients can be provided, forexample, based on payment plan. In one example, a live connection isavailable to only higher paying patients. In another example, a web-caminterface is available only to higher paying patients. Similarly, thepayment plan may dictate other parameters of treatment, for example,complexity of exercises, level of review, interaction between patientsand quality of audio visual effects and/or games. Optionally, the amountof rehabilitation actually provided by the system also depends on thepayer. Alternatively or additionally, the payer is billed according tothe rehabilitation performed.

d) Test and/or train—In an exemplary embodiment of the invention, thegroup is used by the therapist to try out new therapy ideas and receivefeedback form the patients, in real-time on the relative benefits andproblems with different methods. Optionally, such a group is used fortraining purposes, for example to allow a therapist to view multiplepatients at same and/or different conditions, substantiallysimultaneously. Optionally, if differences are identified, the therapistcan be trained to detect such differences and/or be shown how todifferentially rehabilitate for them.

In an exemplary embodiment of the invention, a linked-system scenario iscarried out. In one example, two devices are connected using amaster-slave relationship for example using a wired or wireless (e.g.,BlueTooth, Cellular or WiFi) connection between them, or using a networkconnection between them. A master can be, for example, a son (ordaughter) and the slave is an aged parent whom the son is assisting inrehabilitation. This allows a paretic parent to use the rehabilitationexercises as a means for maintaining contact with the family.Alternatively or additionally, the paretic parent may receive supportfrom family members. Such support may also include advice on how to usethe system and/or on what exercises to try.

Another exemplary usage of linked devices 100 (or a single device withmultiple arms 102) is for child play. In an exemplary embodiment of theinvention, a paretic child plays with a healthy child, each childmanipulating a separate arm or device. Optionally, the motor abilitiesof the paretic child are compensated for by device 100, for example,providing speed enhancement or providing periodic automated action. Ifthe children play a role-playing game or a sport simulation (e.g.,tennis), device 100 can supplement the abilities of the paretic child,while still allowing the child some control over the game, for example,allowing the paretic child to actually perform 20% of the moves. Device100 can control the level of support for the paretic child to ensure alevel playing field.

Feedback and Patient User Interface

Various types of feedback are envisioned for use with exemplaryembodiments of the invention, for example, one or more of:

a) Feedback from a patient. Optionally, a patient can provide feedbackto a therapist, for example, using voice annotations or textannotations. In one example, such feedback is provided during anactivity. In another example, a patient reviews a recording of theactivity and then adds comments. In some activities supported byexemplary embodiments of the invention, a patient is requested tomanipulate a control, when a certain situation is reached, for example,a maximum force. Feedback may also be provided by the patient for a planor progress, not only for individual activities.

In some embodiments of the invention, patient feedback is processed bydevice 100 to modify and/or decide on current or future activitiesand/or their parameters. For example, if a patient marks that a certainforce is a maximum force, later activities will not pass that force. Insome embodiments of the invention, no explicit user feedback isrequired, instead, the system can implicitly determine when a maximumforce is approached, for example based on difficulty in control, andmodel future activities on the thus determined force.

b) Feedback to patient. In an exemplary embodiment of the invention,feedback is presented to a patient, for example, during an activity, inrest breaks and/or after an activity. For example, such feedback caninclude an indication to the user that he is performing an activityincorrectly, that future cycles should be done differently and/or acomparison between current and past performance and/or other statistics.It should be noted that in many cases positive feedback is as importantor even more important than negative feedback. This may depend on therehabilitation method used. A positive feedback can be, for example, anauditory encouragement, a sound of clapping hands, a visual pleasingscreen and/or a score increase.

Various feedback modalities may be provided, for example, speech andaudio feedback, a display containing text or graphics, a marked up videoimage, force or vibration feedback on device 100 (e.g., by tip 108),using a separate element (such as the above pendant) and/or usingvirtual reality devices, such as goggle mounted displays, in which thetype, position and/or other parameters of a mistake (or correct action)are shown overlaid on a real or virtual image of the activity.

As described, for example, in U.S. Provisional Application 60/633,429filed on Dec. 7, 2004, also being filed as PCT application on same dateas the present application and by the same applicant, entitled“Rehabilitation with Music” and having attorney docket number 414/04396,the disclosures of both applications are incorporated herein byreference, the disclosure of which is incorporated herein by reference,music may be used as a feedback modality, especially for patients withlimited cognitive speech and/or visual ability. For example, music canbe used to indicate a quality of motion, be generated by the motion orbe used by device 100 as instructions or cues to the patient.

c) Feedback to therapist. In an exemplary embodiment of the invention, alocal or remote therapist is provided with feedback. Such feedback caninclude, for example, one or more of extent of use (e.g., includingwhether patient is exercising when therapist is not paying attention),force levels, an indication of mistakes, a notification of missing,exceeding or meeting certain parameters, a predefined alert, a motionquality (described below) a safety situation and/or a statisticalanalysis of a current and/or a past activity.

d) Feedback from remote therapist. In an exemplary embodiment of theinvention, feedback is provided by a remote therapist, for example asindicated above of feedback that a patient may receive. Optionally, suchfeedback includes instruction to device 100 whether to repeat a certainexercise and/or modify parameters. In an exemplary embodiment of theinvention, an exercise is defined with, or a therapist can add, breakpoints, at which the therapist, patient and/or device 100 (depending forexample on implementation) can decide, for example, if to modify futureparameters, impose a rest and/or repeat an activity if a desired resultwas not achieved. Such a breakpoint need not be notice by a patient, ifno decision is made by him and a decision is made fast enough or duringa short, pre-defined, break.

e) Feedback from device 100. Depending on the automation level of device100, feedback can be provided by the device, for example indicating athreshold was past or indicating a safety problem.

f) Feedback from sensor patches attached to or image based analysis ofthe patient and/or device 100. Exemplary such patches are describedbelow with reference to FIG. 5.

g) Feedback from one device to another, for example, in a master-slavemode of operation.

In an exemplary embodiment of the invention, speech is part of therehabilitation process. In one example, device 100 responds to orexpects voice commands. In another example, device 100 generates voiceinstructions.

Simple interfaces may be required for some users. In one example,instructions to a user (patient) are simple red/green lights, toindicate go and stop.

A plurality of different types of cues may be provided to indicate aneed to act by the patient, for example, audio, tactile, vibration (ofdevice 100 or of a patch), motion of opposite limb, visual (e.g.,flashing screen) and/or change of speed. In an exemplary embodiment ofthe invention, a jolt, for example an audio blast (or shout) is used toalert an otherwise non responding patient, for example.

In an exemplary embodiment of the invention, a dummy body is used toshow the patient the effect of the motion of device 100 (e.g., arm 102)on the patient.

Optionally, the complexity of the interface used increases as thepatient rehabilitation progress and the patient's cognitive abilitiesimprove and/or the patient has more attention to spare. Optionally, forexample as described below, the user interface is used for performingconcurrent cognitive, perceptive and motor rehabilitation, for example,by selecting the interface used to match an ability of the patientand/or train the patient in certain non-motor activities.

Mental State

As noted above, the progress of rehabilitation of any particular patienttypically depends on one or more of the following: cognitive ability (ifthe patient cannot think clearly, motor planning is difficult orimpossible), mental ability (if the patient has no motivation,rehabilitation is difficult) and motor capabilities.

In an exemplary embodiment of the invention, one or more of these may bemeasured and/or supported by device 100. Optionally, changes in thedegree and/or type of support are determined by system 100.Alternatively or additionally, changes in support are determined by auser, or a plan of how to change support according to scores, is set bya user.

Support of cognitive abilities is, for example, by providing a simpledisplay, multiple modes of presentation of information, reminders and/ormultiple cues. Cognitive abilities may be tested, for example, byproviding tests or by assessing performance in games where cognitiveability is required. In some cases a distinction is made betweencognitive abilities and perceptive abilities.

In an exemplary embodiment of the invention, the patient is required toexecute a motor task (e.g. move forward) his ability to understand thetask depends on the cognitive capabilities. The ability to see a targeton the screen or actually receive the instructions (e.g., visual orverbal) depends on his perceptive abilities.

Support of motor capabilities is, for example, by the various modes ofmotion described above. Measurement of motor capabilities is, forexample, by providing exercises having a standard range of results andplacing the results on a known scale.

In support of the mental state, various methods are provided herewith insome embodiments of the invention:

(a) Device 100 (or a remote controller) can supply the initiativeinstead of the patient, for example, initiating motions and initiatingexercise repeats.

(b) Device 100 can provide incentive, for example, scores, specialfeedback elements, such as images, jokes, funny icons, laughter and/orrest periods.

(c) Device 100 can support groups, where members of the group providemotivation for each other, for example, via cooperation and/orcompetition.

(d) Device 100 can provide games.

(e) Device 100 can indicate a lack of motivation which suggests a needto provide consoling.

(f) Device 100 can increase patient motivation and reduce fear bypresenting safety features and/or features design to reduce pain (e.g.,a user indicating a pain range and device 100 ensuring that the painrange is exceeded only when the patient is forewarned). In an exemplaryembodiment of the invention, a user indicates a pain range to device 100by pressing a control when a pain point is reached or by a therapistdoing so. Specialized pain sensors may be used as well, for example,detecting nerve activity or detecting physiological changes such assweating or increased pulse.

(g) Device 100 can selectively provide positive feedback or negativefeedback.

(h) Device 100 can be set to more or be less forgiving of errors.

(i) Device 100 can track which exercises seem to inspire more motivationand/or cooperation from a patient.

(j) Device 100 can provide attention instead of a patient, for example,continuing attention to ensure that a motion once started is carriedout. If a mistake occurs, instead of the patient being required tonotice it, device 100 can detect the mistake and provide a cue tocorrect the motion—thereby reducing the mental and cognitive load on thepatient.

While motivation and other mental states such as depression andwithdrawal may be estimated by a human, in an exemplary embodiment ofthe invention, they are measured or estimated by device 100 by detectingtheir effect on performance. In an exemplary embodiment of theinvention, device 100 assesses, for example, one or more of: how hard apatient works, how well the patient carries out his task, progresswithin and between sessions, expected responses to stimuli and/orvariability between different tasks and/or along a task.

In one measurement method, a patient's performance on a task is comparedto the patient's performance (e.g., range of motion, speed accuracy) ina game. Under the assumption that playing a game increases motivation,differences in performance between a game and an exercise, may indicatethe degree of motivation difference between desired and undesired tasks.

In another measurement method, device 100 is used to measure the rangeof a patient's abilities, for example, ROM (range of motion), pain limitand the like. It is assumed that a diagnosis session can be trusted toprovide relatively accurate information about the patient's ability, atleast for the reason that the patient knows the diagnosis session islimited in scope. Thereafter, exercises at the edge of the patient'sability are provided to the patient and a determination is made of thenumber and success of attempts to reach the edge of the range. Thisdetermination may be used as an indication of motivation (e.g.,willingness to achieve what is known the patient can achieve). In anexemplary embodiment of the invention, the exercise comprises providingperformance targets to the patient and the patient is expected to reachfor the targets.

In another measurement method, a self-calibrating method, a patientplays a game in which some of the targets are at the range of thepatient's ability. As this ability might not be known in advance, avariety of targets of different levels of difficulty, are provided. Inan exemplary embodiment of the invention, motivation is assessed byanalyzing the game to determine, first, what the patient's abilities areand, second, how often the patient tries to reach the edge of hisabilities.

Another method of measurement is tracking how hard a patient works(e.g., how long are rest periods). Another method is determining thehardest a patient works in any particular exercise. Another method isdetermining if a patient provides attention, involvement and/or activityin a free-play session, where a patient can exercise if he wants to, toany degree of difficulty the patient wants. Attention is optionallydetermined by comparing trajectories of motion at different times, forexample to see the range of variability (e.g., does a patient suddenlyslow down—maybe his attention wandered). Involvement is optionallydetermined by tracking modifications requested by the patient, forexample in exercises where a patient can select one of severaltrajectories.

In an exemplary embodiment of the invention, mental state is estimatedby analyzing handwriting or gross motor movements, for example,detecting unusual tremors, ticks or other signs of tension and/or lackof control (e.g., as compared to other times). It should be noted thatmental states, in some cases, may be provided as a relative state rarerthan absolute values.

Exercises

In an exemplary embodiment of the invention, existing physicalrehabilitation exercises are used for device 100. However, variousmeasures can be provided not currently available. In some cases, theexercise is modified to take into account limitations of device 100 orabilities of device 100. Optionally, correct motions are determined withexactitude and/or with a degree of control not possible manually. Inaddition, some exercises are described herein which are not possiblewithout robot support (or other techniques described herein).

In an exemplary embodiment of the invention, exercises are modifiedmanually. In an exemplary embodiment of the invention, exercises arerecorded by a therapist and then annotated (e.g., to mark desiredmeasurements). In another example, exercises are directly programmedinto device 100. Optionally, device 100 suggests limitations oradditions to exercises, for example, safety limitations or devicelimitations and/or suggest where a less supportive or more supportivemotion mode may be appropriate (for example at an end of a motion a moresupportive mode may be advisable).

In an exemplary embodiment of the invention, a reaching exercise isperformed by the patient. In such an exercise, various muscle groups canbe trained and various levels of difficulty can be provided.

In an exemplary embodiment of the invention, reaching movements aredefined by one or more of the following exemplary parameters:

Reach Distance:

-   -   Close—touching the body or several inches from the body    -   Mid—in the mid range from full to close    -   Far—almost at full arm extension

Reach Direction:

-   -   Up/Down—from a lower/higher reach location to a higher/lower        location    -   Out/In—moving away/to the body    -   Lateral/Proximal—moving out from the body laterally/moving        toward the body

Reach Height:

-   -   Above head    -   Eye level    -   Shoulder level    -   Torso level

Reach Target:

-   -   Free reach—movement to general location in space with no target    -   Target reach—movement to a physical target    -   Simulated target—movement to a target presented on a computer        screen

A particular “Reach” is defined by the starting location and the endinglocation of the hand as defined by its distance, direction, and height.Any reach may also be further understood in terms of the involvement ofthe arm joints and the ability of the patient to individuate the jointsto achieve the reach.

In an exemplary embodiment of the invention, one or more of thefollowing measures is defined:

Ability of the patient to perform the reach;

Smoothness of motion;

Time to achieve the reach end point;

Accuracy of the reach;

Work or power performed;

Comparison of motion trajectory to normal trajectory patterns for reachmovements;

Number of repetitions of the reach the patient can perform;

The stability of the performance with subsequent repetitions.

In an exemplary embodiment of the invention, a reach training comprisesthe following general steps:

5 to 10 repetitions to reach under guided motion. Patient will beinstructed to attempt to move with the device 100.

5 to 10 repetitions initiate mode. The magnitude and direction of forceof the patient will be measured by device 100. When the threshold forcorrect intention is exceeded, device 100 will guide the patient toaccomplish the reach.

5 to 10 repetitions assisted mode. The patient will attempt to performthe reach independently. Device 100 will measure the intention andassist the patient to move. Over time, the amount of assistance will bereduced as the patient is able to move more independently.

5 to 10 repetitions of free motion. Patient will attempt to perform thereach free of assistance from device 100.

Another exemplary exercise is mimicking of daily activities, such asmoving a full cup between points and lifting a book.

Programming

In an exemplary embodiment of the invention, various aspects of arehabilitation process can be planned and inputted as instructions to acomputer (e.g., device 100), including, one or more of:

a) designing a new exercise;

b) modifying an exercise for a particular situation and/or patient;

c) designing and modifying a rehabilitation plan; and

d) designing and modifying decision logic (e.g., breakpoints, thresholdsand repetitions).

Permissions may be different for different users of system 200 and/ordevice 100, for example, different permissions may be allowed for one ormore of adding new, copy, modify, delete and/or edit. These activitiesmay apply, for example, to one or more of patient data, activity, plan,statistics and/or data logs. Particular activity parameters which may becreated and/or modified in accordance with exemplary embodiments of theinvention include: trajectories, locations and ranges (e.g., minimum andmaximum speed and angles); force parameters, number of repetitioncycles, stop decision(s) and/or rest periods length and frequency.

In some embodiments of the invention, one or more libraries are providedas a basis for modification and for storing programs, for example, aplan library, a per-patient library and/or an activity library.

In an exemplary embodiment of the invention, entering a new trajectoryis by physically manipulating tip 108 (e.g., by a patient with a goodhand or by a therapist). Optionally, the resulting trajectory(s) arethen edited on a computer. Alternatively or additionally, a 3D CAD/CAMprogram may be used, optionally one in which a human body is modeled andvarious constraints can be placed on movement of points on the bodyand/or a desired or allowed range of motion for such points defined.Optionally, a graphic design program is used, for example, with a userindicating a few points of a trajectory and the program completing themwith a line or a curve. Alternatively or additionally, a user may definevarious geometrical shapes, such as a circle, for example by providingpoints and/or a formula. Alternatively or additionally, a user may makea drawing and scan it into system 200 (e.g., at a station 204 or atdevice 100).

In an exemplary embodiment of the invention, an exercise is calibratedfor a particular patient and/or situation. Such calibration may include,for example, one or more of:

a) calibration to patient abilities, such as angular range of motion ofa joint or ability to apply force or maintaining fine positionalcontrol;

b) calibration to a size of a patient, for example, the length of a limbor a bone;

c) calibration to progress, for example, a plan may have its time spanand/or its step size changed based on exhibited or expected progress.

As noted above, a path carried out by a patient or by a therapist may beedited and used for an exercise. In an exemplary embodiment of theinvention, editing includes one or more of smoothing, adding pointsand/or path sections, converting the motion into primitive motionselements,

Exemplary Programming Language

Table I, below, describes an exemplary high-level programming languewhich is optionally used to program device 100, in lieu of learning arobotic programming language. In an exemplary embodiment of theinvention, this language is used by the therapist and/or other user.Optionally, existing exercises are storable and modifiable.

This high-level language is based on library of Icons (each representinga command) that can be dragged into a program area in order to build (oredit) a program. Each icon represents a command; with 3 types of commanddefined (more may be added):

a. Motion command—basic motions, such as line and circle. Each commandhas start point (P1) and stop point (P2), for every motion command thespeed, force acceleration/deceleration time can be set. Setting thepoints (P1, P2) can be done by pressing the enter key while tip 108 isat the desired point.b. General command—such as start/stop program, delay and record.c. Accessories command—a set of command that handle the external devicesand accessories that can be attached to device.

Every command has a set of parameters that may be entered (if not, adefault parameter value may be used). An operator can add comments toeach command. Device 100 generates a description for each command, toevery command the operator can add comments, and every command has adescription. Not shown are commands for instructing users and parameterswhich define what behavior device 100 should carry out under certainconditions. Optionally, each path section may include one or moretriggers, which, upon activation, execute short sections of code. Oneexample is a trigger activated when a user varies his speed more than10%, in which case a warning is provided or a more assistive motion modeis provided.

TABLE I command types Motion commands Line Left p1, p2, F, S, Text Press@ P1 & F - force S - press @ P2 Speed Curve Left p1, p2, p3, F, S Use P1to start P3 system as end & P2 as interpolates Via point and curveCircle/ Left C, R1, R2, F, S, Text For ellipse use ellipse or P1, P2, P3R2 not 0 Teach Left P1 . . . Pn, F, S, Text system points interpolatesbetween points Teach Path Left Path, F, S, Text System samples samplerate path General commands Start Both Text first program command stopboth TXT - Text end of program Delay/Pause Left T - Time (second) can beused for or B - (button waiting on name); TXT certain button press Cycleboth N; No. Of allow to disply repeated cycles; No. Of cycles TXT Recordright 3 level data Position, Indicate record accuracy: Normal force,speed, mode on/off Fine coarse accelaration,, jerk, I/O state, preload,brake setting analysis right use “eval” command, for example read inputboth Read (string); use as input logic may be TXT mechnism used with ifinput Accessories commands Handle right Handle 1 pinch pinch/grip pinch(on/Off, force handle range (kg/Lb)) Handle grip Handle 1 grippinch/grip (on/Off, force handle range (kg/Lb)) wrist Handle wrist wristhandle motion 3Xrange of force elbow

Table II is a sample program, using the language shown in table I. Aprogram structure has several columns; the first one is the main commandthat are sequential, the second and third columns are for commands whichoperate in parallel.

When a new program is started, the start and stop commands optionallyare provided automatically. Other commands are manually inserted betweenthe start and stop.

Table II is a sample program of a path having 3 straight lines (can berectangular), with a delay in between, and during the second line anexternal device is operated (for example—waiting for input from handle).All data during the second and third lines is recorded and the entireprogram is repeated 5 times. Modifiers for the repetition (e.g.,increase speed, increase required accuracy) are optionally provided asparameters. General program parameters, such as type of scoring,expected quality of motion are optionally provided as well.

TABLE II program sample Prog name description date file name: trial1glass grip auto date xxx.prg optional optional Commands command commandParameters comments 1 start 2 line P1 (start PA (value) patient point)P2 active must exceed Force force value; PP Patient (PA[VALUE]/passive - no force value PP) 3 delay/pause D (1 sec) 4 handle pinchrecord 1 kg < force < display grip force 5 kg during run if not in rangedisplay warning message 5 line handle pinch record P1 P2 Force (PA[VALUE]/PP) 6 delay/pause handle pinch record D (1 sec) 7 line recordP1, P2 (start point) 8 cycle record N = 5 9 stop

A particular type of control provided in accordance with someembodiments of the invention is spatial programming control. In thistype of control, certain gestures or positions in space of tip 108 aretranslated into commands for device 100. In one example, such gesturesmay be used by a therapist or by a patient to fast forward past anexercise section.

In another example of a shortcut, wrist movements of a therapist will betranslated into arm (or other limb) motions, thus allowing the therapistto make smaller motions and only with his hand, rather than the limbwhose motion is being programmed.

Sensing and Control of Limb Position

In device 100, as illustrated, only one point of the patient iscontrolled, the point in contact with tip 108. However, this means thatmultiple different arm motions can result in a same spatial trajectory.For some situations this is not a problem. For example, for recoveryfrom stroke, in some cases, any motion is useful. In otherrehabilitation scenarios, it is desirable to better dictate or know thepositions of all the moving body parts. In some exemplary embodiments ofthe invention, the position of other body parts is fixed. For example, apatient may be strapped to a chair (e.g., the shoulder of the patient)and/or a rest may be provided for an elbow. This restricts possiblemotions by a hand holding tip 108.

FIG. 5 illustrates a system 500 including limb position sensing and/orrestricting, in accordance with an exemplary embodiment of theinvention. Correct motion of other parts of the body than the hand thatcontacts tip 108 may be provided, for example, by detecting thepositions and providing feedback, for example, audio or visual feedback,to the patient.

A patient 506 sits in a chair 514 and uses device 100 (or a device asdescribed below in which the arm is mounted on a ball). One or morecameras 502 image the arm and/or other parts of patient 506 anddetermine the spatial position and/or velocity thereof. Alternatively oradditionally, one or more cameras 516 are mounted on device 100 for suchimaging. In some implementation of image based reconstruction of bodypositions, it is useful to include one or more fiduciary markers 504,for example strap-on patterns or LEDs.

Alternatively to image based position sensing, magnetic, electric,ultrasonic or other contact-less position sensing and orientationsensing methods may be used. Many such position determination methodsand devices are known in the art and may be used. In an exemplaryembodiment of the invention, a reference position is provided on device100 and/or on tip 108. Optionally, such position sensors are used fordetermining the state of device 100, instead of or in addition tomechanical sensors in device 100.

Alternatively or additionally to using contact-less position sensing,mechanical based position sensing, for example using an articulated arm,may be used.

It should be appreciated that in some embodiments of the invention noarm 102 is provided, instead position sensors of some type are used.Feedback is optionally provided via virtual reality type displays andfeedback (e.g., vibration to emulate force). However, this may not allowdirect force feedback and resistance to be applied, as desired in otherexemplary embodiments of the invention.

In an exemplary embodiment of the invention, patches 504 are used toprovide feedback or cuing to a patient. In an exemplary embodiment ofthe invention, a patch includes a wireless receiver, an optional powersource and a stimulator, for example a vibrator, pin-prick, a pincher ora heating element. Upon command from device 100, patch 504 can provide astimulation to the patient. Patch 504 may be wired instead of beingwireless.

In an exemplary embodiment of the invention, sensed positions of bodypoints are used for one or more of:

a) determining if a body motion is correct;

b) determining what motions are possible (e.g., based on angles ofjoints);

c) learning desired motions from an example;

d) monitoring a patient's ability (e.g., for testing or limbmeasurements); and/or

e) determining if a body posture is correct during, before and/or afterexercise and when changes occurred.

Alternatively or additionally to position, orientation and velocitysensors, physiological sensors may be provided, for example one or moreof pulse measurement sensors as known in exercise machines and gripand/or pinch force sensors in tip 108. Alternatively or additionally,one or more physiological sensors may be provided on the patient, forexample, breath rate sensors.

Referring back to FIG. 5, alternatively or additionally to positionsensors, a body rest 508 may be provided for one or more body parts. Inthe example shown, rest 508, attached to chair 514 by a (optionallyadjustable) bar 510 prevents motion of the chest and/or shoulder. In analternative embodiment, one or more straps are used to hold body parts.

In an exemplary embodiment of the invention, reverse kinematics methodare used to estimate the motion and/or dimension of a patient's jointsand/or bones. For example, if a limb is fixed to rest 508, movement oftip 108 can be used to estimate the actual motion of the joint. Whenharness 508 used to lock the elbow is in a fully extended position, thedistance from the shoulder to wrist can be calculated as the patientmoves the arm. If the handle of FIG. 15F is used and patient isrestricted by a shoulder harness then the forearm length can bedetermined Alternatively or additionally, a force field can be used torestrict the motion in a manner which will guarantee that limb dimensioncan be determined.

In an exemplary embodiment of the invention, a model of the patient isconstructed for use in such reverse kinematics calculation. Also, insafety calculations, such a model may be used. For example, a motion maybe prevented as being unsafe if a patient can possibly reach aconfiguration of joints where the motion is unsafe. The reach of eachjoint may be dependent, for example, on fixation of the patient (e.g.,harnesses), measured ROM and assumed ROM.

Optionally, chair 514 is fixed to device 100, possibly in an adjustablemanner, for example, using a fixation bar 512. Optionally, an initialcalibration process is carried out, for example when first doing a newactivity or during device setup. In one example, bar 512 includesgraduations and during calibrations the correct setting of the chairrelative to the graduations is determined.

In some embodiments of the invention, device 100 comes with a built-inchair 514. Exemplary positioning of a movable chair is described below.

In an exemplary embodiment of the invention, positioning sensing is tobetter than 1 cm, 5 mm, 2 mm or 1 mm, over the entire working volume ofthe device. In some embodiments, a lower absolute positioning accuracyis tolerated if a relative accuracy, within an exercise is maintained.

In an exemplary embodiment of the invention, accuracy of force controlis better then 100 gr, 50 gr, 10 gr or better. Optionally, the balancingof the arm is within these values. Similar accuracies may be providedfor measurement. Optionally, sampling rate of better than 10 Hz, 50 Hz,100 Hz or more is provided.

Patient Positioning

In some embodiments of the invention and/or exercises, the patientposition is not important. However, in many exercises, correct targetingof a certain joint, tendon and/or muscle group may require precision inmotion of tip 108 relative to the patient and/or in the posture of thepatient and or other body part.

In an exemplary embodiment of the invention, straps, a harness and/orrest 508 are provided to set the position of the patient. Optionally,one or more bars 512 links chair 514 to device 100. Alternatively to abar, reference 512 represents a spring-loaded wire, which includes aposition sensor to indicate its retraction and thus the position ofchair 514 relative to device 100. Optionally, a plurality of retractablewires are used. Optionally, each wire includes a ring into which a legof chair 514 is placed. Optionally, if the chair moves during a session,the exercises are corrected on the fly to account for the new relativeposition of chair 514 and device 100. Alternatively or additionally, ifmotion of the patient is detected during a session, for example motionfrom one posture to another, the exercises are adapted to reflect thenew position. Optionally, a plurality of typical static postures of thepatient are learned and the system uses these learned postures todistinguish ongoing motion from semi-permanent postures. Optionally,change in posture is detected by changes in pressure on various pressuresensors, or using cameras which image the chair, device and/or patient.Alternatively or additionally, changes are detected by detecting changesin the actual trajectory followed by tip 108.

Optionally, a mat 518 is provided. In one option, mat 518 is a pressuresensitive mat for detecting positions of chair legs or patient legs.Optionally, calibration is performed for the chair that the patientactually uses. Alternatively or additionally, the mat is used to allowmanual entry of relative position. Alternatively or additionally, themat includes markings that are recognizable by a camera that images themat.

In an exemplary embodiment of the invention, tip 108 is used todetermine the position of chair 514. In one example, once chair 514 islocked in place, tip 108 is used as a digitizer by contacting points onchair 514 and/or the patient. In some cases an adaptor tip may be placedat tip 108. Optionally, once a patient position has been digitized once(e.g., under therapist guidance), next time chair 514 is brought todevice 100, tip 108 is moved by device 100 to indicate a desiredposition of chair 514 or the patient.

Optionally, a laser or light pointer is attached to tip 108 (or otherpart of arm 108 or device 100) and serves to generate a light marking ofa desired location for a chair and/or patient part. Device 100optionally converts between the coordinate systems of the pointingdevice, arm 108 and/or chair.

In some embodiments of the invention, it is not tip 108 which has to beat a certain position, but the patient's hand or finger. Optionally, adummy hand is placed in device 100 and used for such calibration.

It should be noted that positioning methods as described herein may alsobe used for positioning other parts of the rehabilitation system, forexample, a table, a glass, a second device 100 or a kit for dailyliving, for example as shown in FIG. 19H.

In an exemplary embodiment of the invention, patient positioning isdetermined by patient kinematics. In an exemplary embodiment of theinvention, once a patient is positioned, the patient performs one ormore exercises and the patient position is determined based on theactual trajectories followed. In some cases, a previous ability of thepatient, for example, joint range of motion, needs to be known in orderto determine the patient position.

In an exemplary embodiment of the invention, the patient performsswinging of the arm, without bending the elbow. The radius of the motionindicates the position of the shoulder joint. If the patient cannotstraighten his elbow (or keep it straight) this information isoptionally used.

In an exemplary embodiment of the invention, it is assumed that patientmovement between sessions is mainly translational motion in a 2D plane,so only one motion of the arm is sufficient for position calibration.Optionally, two arms are moved, to assist in detecting body twist.

Optionally, alternatively or additionally to determining patientposition, an initial set of patient movements are used to extract basicinformation about the patient, such as range of motion and freedom ofmotion. Optionally, device 100 first applies or suggests a series ofexercises meant to warm up muscles and joints, before takingmeasurements.

Attachment to Body

In FIG. 1, tip 108 is held in a patient's hand. To attach to other partsof the body, other means may be used. In one example, a strap or elasticring is provided at end 108 instead of a ball-like handle. In anotherexample, a rod-like handle is provided instead of a ball-like handle.

FIG. 6 shows an elbow holder 600, in accordance with an exemplaryembodiment of the invention. Such an elbow holder can be used, forexample, when the motion required is of the shoulder, so an elbow 616 iswhat moves along a trajectory. A base 602 is adapted for attachment attip 108. A hinge 604 allows relative motion between a first part 606 anda second part 608 on which an arm 614 rests. Optional straps 610 and 612optionally attach arm 614 more firmly to holder 610. Optionally, joint604 has a varying resistance, for example settable by the patient and/orby device 100. Alternatively or additionally, joint 604 includes anactuator for applying force to close or open elbow 616. Alternatively oradditionally, joint 604 includes an angle sensor. Optionally, holder 600can vibrate the elbow, for example as a therapeutic effect or to helpprevent freezing of the joint. Such vibration may be applied to otherjoints and body parts as well, for example, using suitable attachments.

In an exemplary embodiment of the invention, holder 600 functions as aspastic harness in one example, joint 604 is locked (or is not a joint)and arm 614 is forced open and held by straps 610 and 612.

In an exemplary embodiment of the invention, parts 608 and 606 areraised so that joint 604 has a center of rotation which is substantiallythe same as elbow 616, in one or more planes.

In other embodiments of the invention, attachment to other points on thebody is provided. In particular, it is noted that in some embodiments ofthe invention, what is constrained is a joint, while in other, what isconstrained is a bone or a certain location on a bone. As noted above,various types of constraints can be provided, for example, constraintson angular and/or spatial dimensions. Additional attachments aredescribed with reference to FIG. 16 below.

In an exemplary embodiment of the invention, the attachment includes acoded circuit or other means so that when attached to arm 102, device100 is aware of the type of attachment.

In some embodiments, the attachment is fitted with a quick connectingelements made out of two mechanical quick connect parts (e.g., springloaded pin and slot arrangement) and an electrical quick connect (e.g.,spring loaded small needle contacts), this allows a fast change overfrom exercise to exercise or from patient to patient. In an exemplaryembodiment of the invention, each attachment includes a chip andreceives power form the connector and sends data (if any) on a bus, forexample a packet-type bus. Alternatively, the electrical connector isused to directly interface measurement means (e.g., a potentiometer) ofthe attachment, to device 100.

Instructing of User

Device 100 can provide instructions to a user in many modes, including,one or more of (for various embodiments of the invention):

a) recorded speech.

b) computer animation display.

c) instruction videos.

d) motion of device 100, while patient is not attached.

e) motion of device 100 while patient is attached, possibly at a slowerspeed and with commentary.

f) motion of device 100, with a dummy attached.

g) using musical notes, for example as cues or to set a tempo of motion.

h) motion of a second device 100, for example as a demonstration or insequence with the patient's own motion.

Training, Teaching and Quality of Motion (QoM)

While one part of a rehabilitation plan is often exercising a body partto maintaining or increase strength or range of motion, in an exemplaryembodiment of the invention, rehabilitation includes teaching a patientquality aspects of motions and/or what motions are correct.

In an exemplary embodiment of the invention, one or more of thefollowing qualities of a motion are of interest:

a) degree of utilization of available joints and/or joint range ofmotion;

b) usage of muscles where they can apply sufficient force;

c) motion where joints and/or muscles can achieve a better accuracy ofcontrol;

d) motion which does not approach thresholds of ability;

e) motion which does not approach danger areas (for example for apatient with unstable joints);

f) smoothness in motion and/or rotation;

g) distance traveled;

h) maximum force required;

i) spatial and/or energy efficiency of motion, e.g., extra motions;and/or

j) motion with minimum jerk

In an exemplary embodiment of the invention, quality of motion is judgedusing a power law, which characterizes motions by healthy individuals.Paretic individuals are optionally characterized as to how closely theyreach this law and for which joints and/or motion types it is reached.

Optionally, ‘Healthy movement’ is described by basic kinematiccharacteristics that define quality of motion. For the arm, one suchcharacteristic is a smooth transition of the hand from one point toanother following roughly the shortest path between the two points. Asecond characteristic is that the velocity of the hand is constrained bythe curvature of the path (Viviani P, and Terzuolo C. Trajectorydetermines movement dynamics. J Neurosci 7, 1982: 431-437, thedisclosure of which is incorporated herein by reference). The larger thecurvature of the path, the slower the movement of the hand is, at aconstant ratio of ⅔. These kinematic descriptions are definedmathematically, and thus, they can be used for an objectivequantification of the quality of movement.

A “Minimum Jerk” can explain the smooth and shortest movementcharacteristics often observed in healthy people, while the “Two-thirdsPower law” has been developed to validate the relation between pathcurvature and hand speed. More recently, both rules have been unified(Viviani P, and Flash F. Minimum-jerk, two-thirds power law, andisochrony: converging approaches to movement planning. J Exp Psychol:Hum Percept Perform 17: 32-53, 1995, the disclosure of which isincorporated herein by reference) and mathematically defined as twoaspects of the same intention (Richardson M J E, and Flash T. Comparingsmooth arm movements with the Two-Thirds Power Law and the relatedsegmented-control hypothesis. J Neurosci 22: 8201-8211, 2002, thedisclosure of which is incorporated herein by reference). These tworules combined in one single description can be adopted for testingquality of movement before, during and/or after treatment with device100. Optionally, power law fitting is determined by providing thepatient with a range of motions, at different speeds and extractingpower-law information from the results. The law may be applied to otherjoints and limbs, such as lower limbs.

Another law which may be applied relates to the relative motion of eachjoint in a coordinated motion. In healthy persons such motion takes intoaccount the relative distances of the various joints from the target ofmotion and the different accuracies of such joints. Another law whichmay be applied is Fits law which relates a size of target to a time tohit the target.

These qualities may be general for a motion or particular for a patientwith certain abilities and lacks.

In an exemplary embodiment of the invention, such qualities of a motionare taught to a patient by example, for example, leading an arm throughcorrect and incorrect motions. Such motions may be entered for exampleby the therapist or by the patient or be pre-programmed. Alternativelyor additionally, a patient motion is recorded and corrected and then thepatient is paced through the incorrect and the corrected motions. In apre-defined motion, the motion may be calibrated for the particularuser, for example for the user's size.

Optionally, a threshold of correctness is defined, for a patient toattempt to keep all his motions as being of a quality (in one or moreparameters) above the threshold.

Alternatively or additionally, such qualities are taught by a commentingin real-time or off-line on a patient's motions.

Thus, in some embodiments of the invention, a substantial part ofrehabilitation comprises exercising a patient in motions which arecorrect or teaching the patient how to know if a certain motion he hasperformed is of a higher or of a lower quality.

Other types of training are not related to motion correctness. Forexample, a patient may be trained to not ignore a damaged limb. In arelated aspect, however, a patient may be trained to use a damaged jointas part of “correct” motion, so as not to reduce a range of motion ofthe joint.

In one example, the relative motion expected between an elbow and awrist is known (e.g., or is inputted by a therapist, such as by example)for certain motions, such as moving objects on a table surface. If apatient deviates by a certain amount (e.g., defined by the therapist)feedback is provided.

Paired Motion

In an exemplary embodiment of the invention, motion with a good arm limbis used to train a bad limb. For example, a good arm can be used totrace a circle and then the bad arm is trained to trace the circle. Oneadvantage of such training is the intimate feedback that a patientreceives by better understanding exactly which joints and muscles areused for each motion. In an alternative application, the “good” motionis provided by a therapist or other caregiver.

In a single arm device 100, the following process may be used:

a) Device 100 optionally illustrates a correct motion, in actuality oron a display.

b) A motion is executed with a “good” limb. Optionally, the motion iscorrected, using methods as described above for editing.

c) The motion is repeated with a “bad” limb, for example using passivemotion, free motion or a force field. Optionally, the “good” motion iscorrected before being applied to the bad limb, for example, an expectedspeed reduced, a range of motion reduced or a force reduced.

d) Feedback is provided to the patient during and/or after the motion(e.g., as a display).

e) The motion is optionally repeated.

FIG. 7 and FIG. 8 shows two handle devices 700 and 800 respectively, inwhich two arms can be moved simultaneously, with optional coupling. Inan exemplary embodiment of the invention, this is used to have one armpassively move the other arm, for example so the patient can sense withthe good arm what a bad arm is doing, or vice versa. Alternatively oradditionally, one handle is moved by the device, so the patient can seewhat is expected of him. Optionally, two arm devices are used forchildren, for example as a game between paretic children and healthychildren or grownups.

In device 700, two separate rehabilitation devices 702 and 704 areoptionally attached by a base 706 and coupled by computer, electricallyand/or mechanically, so that an arm 708 of one mimics the motion of anarm 710 of the other. The arm moving mechanism is optionally a ballbased mechanism as described below.

In device 800, a single joint links two arms 808 and 810. As a result,the motions are reversed. Optionally, arms 808 and 810 are extendible(as described below, for example) and are linked together so that theyboth lengthen and shorten together, for example, the two arms includingextensions that are engaged on opposite sides of a gear with a fixedcenter of rotation (e.g., a rack and pinion mechanism).

In an exemplary embodiment of the invention, mirrored motion is providedusing other devices. For example, in an application using standarddevices, mirrored motion is provided by a user holding one mouse ineither hand (or in a same hand sequentially) and applying the abovetransfer of motion form one hand to the other. In another embodiment,one or two force-feedback joysticks are used. It should be noted thatfor this and other embodiments a plurality of devices may be used. Inparticular, for specific applications, relatively simple and/or standardhardware can be used, for example force feedback joysticks or hapticdisplays.

Complex Motion

FIG. 9A illustrates a rehabilitation device 900 comprising two sections,a first section 902 associated with motion of a wrist and a secondsection 904 associated with motion of an elbow. Sections 902 and 904 canbe ball-based devices as described below. A rigid and optionallyadjustable connection 910 fixes the relative position of sections 902and 904. A connection 912 optionally interconnects a wrist holder 906and an elbow holder 908. Device 900 is used to exemplify control ofmultiple points on a limb (e.g., arm or leg) during rehabilitation.

In use, each of holders 908 and 906 can be controlled in three spatialdimensions and optionally in angular dimensions as well, thus allowingmore complex motions to be tested, trained and/or provided. Optionally,the possibility of restricting certain motions is useful from a safetypoint of view, for example, preventing certain rotations of the joints.Optionally, a point is controlled in 3, 4, 5, or 6 degrees of freedom ofmotion. Optionally, the control in some of the degrees of freedom isdifferent than in others. For example, motion in one axis may haveresistance associated therewith, while an angular motion may be assistedmotion with device 900 supplying some of the force.

It should be noted that in device 900, trajectories may be defined asrelative trajectories in which the actual position of the device 900 isless important than the relative positions and movement in space ofholders 906 and 908.

FIG. 9B illustrates a rehabilitation device 920, including a singlesection 928 with an arm 932, on which is mounted an arm holder 930.Holder 930 restrains both an elbow using an elbow holder 924 and awrist, using a wrist holder 922. An optional rotation mechanism 926 isshown for rotating holder 930 perpendicular to arm 932 while an optionalrotation mechanism 940 rotates holder 930 around arm 932. Alternativelyor additionally, a similar mechanism (not shown) is optionally providedfor rotating holder 930 around its axis.

As will be described below, another type of complex motion which can besupported by a rehabilitation device in accordance with an exemplaryembodiment of the invention requires synchronized motion of several bodyparts, for example, an arm and a leg.

Ball-Based Device

As noted above, designs other than an articulated arm may be used fordevice 100. In particular, in an exemplary embodiment of the invention,the device is based on a universal joint, from which extends a rigidarm, which is optionally changeable in length.

In an exemplary embodiment of the invention, the universal joint isimplemented as a ball in socket joint. FIG. 10 shows an exemplaryrehabilitation device 1000, using a ball-in-socket joint. This referencenumber is used in the general sense for several ball-based devices asdescribed herein, for conciseness.

Device 1000 comprises a base 1004, for example a table containing aplate 1016, with an aperture 1017 defined therein and enclosing a ball1010. Ball 1010 optionally rests on a plurality of rollers 1012. In analternative embodiment shown in FIG. 11, rollers 1012 are replaced by abottom plate 1015 with an aperture 1013 defined therein which supportsball 1010.

An arm 1002 extends from ball 1010 and is optionally balanced by acounter-weight 1018 attached by a rod 1022 to an opposite side of ball1010. Rod 1022 optionally passes through a slot in an optional guideplate 1020, described in greater detail below.

In use, ball 1010 turns and/or rotates, allowing a tip 1008 of arm 1002to define various trajectories in space. Optionally, arm 1002 isextendible, so that the trajectories fill a volume of space. Optionally,arm 1002 includes a motor or brake 1024 (e.g., an oil brake), toactively move or passively resist such extension.

In an exemplary embodiment of the invention, a brake 1014 is providedfor ball 1010. One potential benefit of using a relatively large ball1010 is that torque at the surface of the ball, for example as requiredfor braking or moving arm 1002 is generally smaller than required forsmaller joints, possibly allowing the use of smaller or cheaper motorsor other mechanical elements. Alternatively or additionally, positionalcontrol of such motors and/or sensitivity of position sensors can besmaller, while still allowing for sufficiently precise control andfeedback.

Device 1000 can be provided in various configurations. In a simplestconfiguration, the device is completely passive and a user can merelyset plate settings (described below) and resistance settings on thebrakes. In a more advanced configuration, resistance can be varied inreal-time by a computer control. In another advanced configuration,sensing of ball and/or arm position is provided (e.g., using sensors,not shown). In another advanced configuration, directional resistancecan be varied (e.g., using a directional brake, not shown). In anotheradvanced configuration, motive force, optionally directional can be setor varied, for example using a plate and/or using multiple directionalmotors (which can also be used to provide resistance).

In an exemplary embodiment of the invention, multiple motors are used tocontrol motion and/or force of arm 1002. The motors optionally includeoptical position encoders, to determine an arm position. Alternativelyor additionally, stepper motors or servo motors are used. Alternativelyor additionally, a separate sensor, for example, one which reads opticalmarkings off of ball 1010, is used. In an exemplary embodiment of theinvention, rollers 1012 are replaced by motors which rotate wheels. Ifone wheel is in a direction (relative to the surface of ball 1010)perpendicular to another such wheel, selective motion in one or bothdirections can be achieved (e.g., if motion perpendicular to the wheelis low-friction slipping motion). Alternatively, only one roller isreplaced by a motor with a turning wheel, wherein the wheel is turned toa direction of motion desired and then rotated to achieve the motion.Directional resistance is optionally achieved using the motor.Alternatively, such resistance is achieved by a combination of the motorapplying force or resistance and a general resistance applied by brake1014. Optionally, one or more strain sensors are provided or integratedin the motor(s), to assess a direction of force being applied to arm1002. Then, the motors can respond with a counter-force, or an assistingforce or a diverting force (e.g., with a component perpendicular to theapplied force), as required.

In an exemplary embodiment of the invention, brake 1014 is operated byraising and lowering the brake towards the equator of ball 1010, whenthe brake has an inner diameter of less than that of the ball.Alternatively, the brake is inflated and deflated as needed.Alternatively or additionally, a circumference of the brake is modified,for example, by it being formed of shape memory alloys which are heatedto cause momentary expansion and/or shrinkage of the brake.Alternatively or additionally, a perpendicular brake is used which ispressed onto the surface of ball 1010 and towards the center thereof.

Alternatively or additionally to a uni-directional brake, directionalbrakes may be used, for example, rubber blades-like pads which resistmotion of the ball along the blade by bend with relatively low frictionto allow motion perpendicular to the blade.

It should be noted that when arm 1002 is extendible, forces applied topoint 1008 generally include also a component along the axis of arm1002, to which brake or motor 1024 may respond and which is optionallytaken into account in the response of ball 1010.

Balance

FIG. 11 shows a balancing of device 1000, in accordance with anexemplary embodiment of the invention. As noted above, FIG. 11 shows avariant of device 1000, in which ball 1010 is supported by plate 1015.Weight 1018 is optionally designed to exactly cancel the moment of arm1002. Alternatively, it may be designed, or modified (e.g., by changingits distance from ball 1010 or by adding or removing a modular weight),to provide a force which return arm 1002 to a resting position or aforce which tends to move it away from such a resting position. In somecases, balancing may be adjusted to correct for a weight of anattachment, or of the patient's limb.

Optionally, when arm 1002 is extendible, the extending part includes amoving counter-weight that extends away from the center of ball 1010 ina manner which maintains the center of gravity of ball 1010. This motionmay be solely inside of ball 1010.

Alternatively or additionally, balancing of ball 1010 is provided byactive balancing by the motors and/or brakes. Such active balancing mayalso be used to effectively reduce or cancel out the moment of inertiaof ball 1010 and arm 1002.

When an attachment is added to tip 1008, this may change the balancing.Optionally, a suitable weight is provided with each such adjustment, foradding to balancing weight 1018. Alternatively, handle 1008 includes oneor more contacts and/or circuitry which match one or more contacts orcircuitry in a mating part of the attachment. This allows device 1000 todetect which attachment is being added and suitably move weight 1018 tocompensate. Suitable tables are optionally downloaded from a remotesite. Alternatively, the attachment includes a peg of suitable lengthwhich pushes into tip 1008 and thereby moves an arm balancing weightinside of ball 1010. Movement of weight 1018 is optionally by a motor(not shown) and may be, for example, along a rod 1022 and/or away from aline connecting rod 1022 and arm 1002. Alternatively or additionally,device 1000 self calibrates by detecting an applied torque moment andmoving weight 1018 (or other weights) to compensate.

Optionally, the balancing is designed relative to an expected weight orforce applied by a person during an activity.

FIG. 11 also shows rod 1022 being constrained to travel in a straightline by a slot 1030 in plate 1020.

Guide Plate

While, in general, computer controlled directional motors and brakes canachieve any desired motion, in some embodiments of the invention, apossibly more limited motion is supported by the use of plate 1020 andits associated slots 1030. A potential advantage of using guide platesis that movement perpendicular to the slot is not generally possibly,and this does not required suitable circuitry.

FIG. 12 illustrates a drive system for a plate-based rehabilitationdevice, in accordance with an exemplary embodiment of the invention. Afirst, optional, motor 1046 is attached to a gear 1048 which rotatesplate 1020 to allow motion of rod 1022 in other than a straight line. Asecond, optional motor 1040 is attached to a threaded rod 1042 on whicha rod coupler 1044 travels. As coupler 1044 travels, it moves (orresists) rod 1022 along slot 1030. Other mechanisms can be used as well.

As noted in FIGS. 3A and 3B, it is sometimes desirable to providevarying, rather than absolute resistance to motion perpendicular to slot1030. FIG. 13A illustrates an exemplary coupling device 1300 forreplacing coupler 1044, and which has this property. Coupling device1300 includes a body 1314 having an inner threaded section 1302 formounting on threaded rod 1042. Body 1314 further comprises an aperturedelement 1306 having an aperture 1304 which engages rod 1022. One or morespring elements 1308 couple element 1304 to body 1314. Optionally, thetension in spring element 1308 can be adjusted, for example by a screw1310. Optionally, a linear displacement sensor 1312 is provided tomeasure the error in the position of rod 1022. Elements 1308 can beprovided, for example, in the direction of slot 1030 and/orperpendicular to it. Other exemplary force control mechanisms aredescribed with reference to FIGS. 22-26.

FIG. 13B shows an elastic guide 1340, formed of two halves 1342 and 1344coupled by one or more springs 1352 and 1354. Thus, a slot 1346 formedbetween two edges 1348 and 1350 of the halves has some elastic give.Alternatively or additionally, edges 1348 and 1350 are made at leastpartially elastic, for example, of rubber.

FIG. 14A illustrates a variant device, in which two guide plates areused in tandem, an upper guide plate 1020 and a lower guide plate 1402.Separate motors are optionally provided for rotating each guide plate.

FIG. 14B shows a guide plate with several slots. The solid areas areprovided to prevent the cut-outs from falling out. Other methods, forexample, out-of-plane bridges, may be used instead.

FIG. 14C shows a guide plate with an “X” shaped slot. Other shapes canbe provided as well, for example a circle with a cross inside, or curvedslots.

In an exemplary embodiment of the invention, programming device 1000includes replacing slots and/or setting resistance. Optionally, when aslot in inserted, it is recognized by device 1000, for example, using acontact based detection scheme as described above or using a wireless orRF communication, for example, by embedding a smart card circuitry inthe plate.

Accessories & Wrist Attachment

FIG. 15A shows a wrist attachment 1500, which provides control and/orfeedback for one or more degrees of motion of a hand, in accordance withan exemplary embodiment of the invention.

A forearm is supposed to rest on a rest 1510, while a grip 1502 isgrasped by the hand. Grip 1502 is gimbaled in one or more axes relativeto rest 1510. In the example shown, handle 1502 is mounted on a base1503 which includes a rod 1504. A joint section 1506 can optionallyrotate around the axis of rod 1504 and/or travel along it. In addition,an optional rod 1508 interconnects rest 1510 and joint section 1506 andallow rotation around rod 1508. In addition, an optional rod 1512 meetsjoint section 1506 at a direction perpendicular to the other two rodsand allows rotation around that third axis.

Optionally, wrist attachment 1500 is attached to tip 1508 at rest 1510or at a base section 1514 attached to rod 1508.

Optionally, one or more of the relative motions described is supportedby one or more motors and/or controllable brakes.

In some wrist attachments (or for other attachment devices), one or moresprings the handle to the rehabilitation device so as to provide thevarying resistance shown in FIGS. 3A and 3B, in one or more dimensions.

FIG. 15B shows a wrist attachment 1520, according to an exemplaryembodiment of the invention and generally following the form of device1500. A handle 1522 is griped by a patient, while the patient's armrests on an arm rest 1524. Optionally, one or more straps are provided(not shown) which can attach via one or more strap slots 1526. A base1542 affords attachment via a connector 1528 to an arm 102 (not shown,but exemplified in FIG. 15C). In an exemplary embodiment of theinvention, a universal connector is used which is suitable for multipleattachments as described herein, for example. In an exemplary embodimentof the invention, the connector provides one ore more of mechanicalfixation, power (e.g., electrical power) and data transfer. Optionally,the connector also provides identifying information about the attachmentto device 100.

In the embodiments shown, three wrist rotations are supported, bymechanical joints 1530, 1532 and 1534. Optionally, the resistance at oneor more of the joints is adjustable. In the embodiment shown, theadjustment is manual, for example using one or more of knobs 1536, 1538and 1540. Alternatively an internal adjustment, for example, using asmall electric motor, is provided. The resistance may be, for example,of a friction type or of a resilient (e.g., spring) type. Optionally,rotation sensors are provided for each joint, for examplepotentiometers.

Optionally, handle 1522 is replaceable, for example, using a pull-pin1544 to selectably unlock handle 1522 for removal.

FIG. 15C shows a different version, of a wrist attachment 1550, similarto wrist attachment 1520 (e.g., a knob 1552 is at a different place fromknob 1538) and shown from an opposite side. Also shown is the mountingof the wrist attachment on an arm 102. In an exemplary embodiment of theinvention, the mounting comprises a ball and socket joint, optionallywith friction resistance. Optionally, the socket joint is designed todisconnect if it experiences torque above a certain level, for exampleas a safety feature. Optionally, this safety level is settable. In anexemplary embodiment of the invention, the joint comprises a ball heldbetween two plates, with the plates interconnected by springs with asettable resistance. A wire interconnecting the plates is optionallyprovided and may generate a signal is torn (e.g., springs overstrained). Optionally, a safety tether is provided to keep the parts ofthe joint together.

Another difference is that instead of a single arm rest 1524, two armrests, 1558 and 1556 are shown. Optionally, straps are provided only forthe far arm rest (1558). Optional padding 1560 is also shown.

FIG. 15D shows a non-vertical handle attachment 1560. While a 90 degreeangle is shown in a bend 1562, other angles, for example 45 degrees maybe provided. Optionally, the angle allows better control over whichmuscles will act and/or may make some motions easier. Optionally, bend1562 is adjustable, for example to preset angles, such as 0, 45 and 90degrees.

An optional universal attachment 1564 is shown.

FIG. 15E shows a grip 1570 in which optional finger indentations 1572are shown. An optional button 1574 for input form the patient is shown.Additional buttons may be provided and buttons may be provided in otherembodiments as well.

Optionally, a body 1576 of handle 1570 is squeezable (as it may be inother embodiments as well). One type of squeezable body includes agas-filled bladder. Optionally, the compression of the gas can be variedto change the resistive force. In an alternative embodiment, body 1576is formed of two panels separated by one or more springs.

An optional universal attachment 1578 is shown.

FIG. 15F shows a two handle embodiment 1580 including two handles 1582and 1586, which are optionally changeable via pins 1584 and 1588. Thisembodiment may be useful, for example, when it is desired for one handto assist the other hand in a motion. The two handles actually used neednot be identical.

An optional universal connector 1590 is shown.

Other attachments may be used as well. In one example, a cup likeattachment is used. A patient can hold the cup as a glass or hold itusing a pinching action by its handle. Various sensors to measurepinching force and or grip force (as may be applied to the glass) may beprovided. Alternatively, attachments known in the art can be used,optionally being modified to include a universal connector and/orsuitable sensors. Optionally, an attachment with a strap to hold thehand is provided.

Optionally, the attachment used provides a sensation to the patient, forexample, vibration, pricking, pinching or a surface texture. Electricalpower may be provided to the attachment, as well as data, to generateand control such sensation. Surface texture may be varied, for example,by providing a smooth layer with an underlay that is bumpy. Extendingthe bumps or the bumpy layer, will vary the surface texture.

While the attachments are described for the arm, it should beappreciated that such attachments can be provided to other limbs and tothe head and neck. In one example, a pedal is provided as an attachmentfor a foot. The various rotations of the wrist attachments may also beprovided for the foot. Similarly, a head and neck attachment may bedesigned to hold the support various rotations and/or movements of thechin relative to the neck.

Another type of attachment is not mounted directly on arm 102, patches504 for example (FIG. 5).

Elbow Support

FIGS. 16A-16D illustrate various methods of elbow support in accordancewith exemplary embodiments of the invention. As noted above, for somerehabilitation methods it is useful to provide support for and/orprevent motion of the elbow (or other body parts). In an exemplaryembodiment of the invention, device 100 supports the weight of the limbso that a patient can focus on moving the limb and not on holding it inspace. Conversely, device 100 may be set to prevent the patient fromleaning on the device, for example, with device 100 providing exactlythe force expected to be applied by the limb (optionally with someleeway). Optionally, the degree of force changes along the trajectory,for example, as the limb extends.

FIG. 16A shows an elbow support 1604 attached by wires to a frame 1602,fixed to the rehabilitation device. Optionally, frame 1602 iscollapsible. Optionally, frame 1602 is designed to allow entry of awheel chair so that a patient on a wheelchair is not required to leavethe chair for rehabilitation. One or more foot pedals 1609 are providedfor exercising and/or other rehabilitation activities of the legs.Optionally, the pedals are used to support coordinated exercises betweenarms and legs. Pedals that move in more than one degree of freedom maybe provided, as well as various sensors as described herein. Aperpendicular motion mechanism 1606 is shown, which may provide room forthe knees of a patient sitting in a wheelchair.

In a simplest embodiment, wires 1605 are set (e.g., their length) to adesired elbow location. Optionally, three wires are used so that elbowsupport 1604 can be fixed in space. Optionally, more wires, for example,four wires are provided, so that even when not occupied, support 1604does not move. While wires may be used to set an elbow support, suchwires may also be used to support other body parts. Optionally, multiplesets of wires are provided, for supporting multiple body parts.Optionally, a wire based system is used instead of an arm 102 or 1002 tocontrol the position of a tip (or attachment) or point on a body.

In an exemplary embodiment of the invention, a wire system is used formeasurement of a position in space. In one example, a wire 1605 recoilsand is attached to a measurement device such as an encoder.Interpolation can be used to provide XYZ coordinates of support 1604. Inanother example, described above as well, wires are used to measure arelative position of a chair and a rehabilitation device (e.g., frame1602).

Optionally, a wire mechanism is attached between two limbs and used todetermine their relative distance. Multiple wires may be used todetermine more than just a distance value.

Optionally, a wire system is used for measuring additional parameters,for example, force applied to a limb (optionally including direction)and speed of motion. It should be noted that a combined system including(for a same point or tip 108) both robotic elements and wire elements,may be provided.

In an exemplary embodiment of the invention, a wire system iscontrolled, for example using a motor, to maintain a certain tension.Optionally, this is used to allow floating support of a limb.Optionally, motors are used for controlling or assisting motion, forexample with a motor being used to shorten a wire or allow a wire toplay out at a certain speed or if a certain force is sensed.

Optionally, a wire 1605 provides compliance against tension, forexample, by providing a spring attached to a wire 1605 (e.g., at a point1608, where a motor may be provided as well). Optionally, the tension inthe spring may be varied, for example, using an electric motor.Optionally, the spring is used to provide cushioning in general.

FIG. 16B shows elbow support 1604 supported by an arm 1610 which extendsfrom the rehabilitation device. Optionally, arm 1610 includes a linearextension measurement element and two rotary measurement elements, toindicate the position of support 1604. Other embodiments describedherein may also include such sensors so device 100 can calculate theposition. Also, as noted, force sensors may be provided, to assist inanalyzing the forces applied by the patient to support 1604.

FIG. 16C shows elbow support 1604 supported by a jointed arm 1620 whichextends from the rehabilitation device.

FIG. 16D shows elbow support 1604 supported by a member 1630 whichextends out of (and/or is mounted on) arm 1002.

Optionally, the extending arms and members are configurable.Alternatively or additionally, the arms include motors and/or variableresistance elements. Alternatively or additionally, the arms and linksinclude position, orientation, displacement and/or force sensors. In anexemplary embodiment of the invention, the actual position of variousparts of the arm may be determined based on the fact that one or moreparts of the arm are fixed and the length is known. If any joints areprovided, the angle of the joint may be measured.

An additional elbow support example is shown in FIG. 19, below, in adocking station.

Varying Orientation

In some embodiments of the invention it is desirable that arm 102 have acenter resting position which is not vertical. FIG. 17A shows arehabilitation device 1700, including a joint 1702 between a base 1704thereof and a movement mechanism 1706 thereof, which can assume multipleorientations.

Alternatively, one of the above described rehabilitation devices may bemounted on a surface other than the floor or on legs with unevenlengths. Optionally, when device 1000 is mounted on a wall or upsidedown, rollers such as rollers 1012 are provided above ball 1010 as well,so that they can support ball 1010, when device 1000 is on its side orupside down. Mounting is achieved, for example, by screws or using anadhesive.

One potential advantage of a varying orientation rehabilitation deviceis the ability to rehabilitate a patient in varying positions. Forexample, some exercises, for example those including reaching andbalance may be usefully practiced while standing up. Some exercises,must be practiced while lying down, as the patient is bed-ridden. Someexercises may be practiced sitting and others while kneeling.

Another potential advantage is that a same system may be used torehabilitate different body parts with a same device.

Another potential advantage of a varying orientation rehabilitationdevice is that many arm motion mechanisms are limited in their range ofmotion, coupling between axes and/or other mechanical considerations.Varying the orientation of the device allows the motion mechanism to beplaced at a more optimal position. It should be noted that in somevarying orientation devices, the controlled tip 108 of the device canstay in a same location even though the motion mechanism has moved. Thisallows, for example, that a patient remain in a wheelchair during achange in exercise.

While a manual change in orientation is shown, optionally one or moremotors are used to effect the change in orientation. One or more anglesensors may be provided to detect the actual rotation of joint 1702 (inone or two directions).

FIG. 17B and FIG. 17C show an alternative varying orientationrehabilitation device 1710, in two orientations. In FIG. 17B, an angledorientation is shown, a support slab 1724 positions a motion mechanism1720 and an arm 1722 relative to a base 1712. Optionally, one or moreextendible legs 1714 are provided for stability. Optionally, awheelchair guide 1716, optionally extendible, is provided. Optionally,guide 1716 is slotted to allow a wheel to enter therein. Optionally,chucks are added on either side of the wheel to lock the wheel in place.Not shown is an optional bracket based locking mechanism in which one ormore pins or brackets engages the wheel from one or both sides thereof,for example along the wheel axis. Such a mechanism may be electricallyactuated, for example, by the patient himself. This wheelchair lockingmechanism may be used in other embodiments of the invention as well.

In an exemplary embodiment of the invention, slab 1724 can be positionedat various angles. FIG. 17B shows an angle of about 45 degrees. FIG. 17Cshows a 90 degree angle. Also shown in FIG. 17C, is a second supportslab 1726 attached by a lockable hinge 1728 to support slab 1724. InFIG. 17B slab 1726 is flat against base 1712. Additional possible modesare a 0 degree angle, in which slabs 1724 and 1726 lay flat in a recess1734 of base 1712. A hinge 1730 is used to rotate motion mechanism 1720so that it faces upwards. Optionally, motion mechanism 1720 is coupledto hinge 1730 via a rotatable base 1721. Another exemplary position iswith slab 1724 lying flat in a recess 1732, so that rotatable base 1721also lies in recess 1732. This is a transport mode, in which arm 1722may be detached and the whole of device 1710 may fit, for example, in atrunk of a car. Slab 1726 is optionally attached to base 1712, byanother lockable hinge (not shown).

FIG. 17D shows an alternative rehabilitation device 1740 with anadjustable position of a motion mechanism 1748 thereof. In thisembodiment, a rail 1744 extends from a base 1742 and motion mechanism1748 is coupled to a traveler 1746 which rides on rail 1744. Optionally,motion mechanism 1748 is attached by a hinge to traveler 1746, to betterutilize the range of motion of mechanism 1748 (e.g., allowing an arm1750 of device 1740 to be centered in a center of a motion space usingtraveler 1746, rather than using mechanism 1748).

Rail 1744 optionally folds for travel. Rail 1744 optionally includes anin-built data and power bus for transferring at least power to mechanism1748. Alternatively, a flexible cable (not shown) is used. Base 1742 (asother bases shown herein) may optionally include wheels.

Multi-Limb Devices

In an exemplary embodiment of the invention, multiple limbs can betrained together, for example, for rehabilitating synchronized motion.In an exemplary embodiment of the invention, multiple modules such asused in device 1000 are attached in various configurations to achievethis effect. The attachment can be, for example, structural (e.g.,preventing undesired relative motion, but possibly adjustable),mechanical, for example transmitting motion from one module to another,and/or controlled, for example, modifying the interaction at one modulein response or in synchrony with interaction at another module.

FIG. 18 shows a rehabilitation device 1800 for an arm and a leg, inaccordance with an exemplary embodiment of the invention. Device 1800includes a first section 1804 for exercising an arm, for example using amechanism of device 1000, and a second section 1802 for exercising aleg, for example also using the mechanism of device 1000.

One exemplary use for this type of device is to rehabilitate a strokevictim with one side paralysis. Another exemplary use is to trainsynchronized motions, such as required for walking.

In some cases, two sided rehabilitation is desirable. FIG. 19A shows arehabilitation device 1900 with four mechanism modules. A pair ofmodules 1902 and 1904 is used to control the movements of a right armand a pair of mechanism modules 1906 and 1908 is used to control themovements of a left arm. The two pairs of modules can be synchronizedand/or used for teaching, for example, as described above.

Optionally, one or more modules are added for exercising each leg. Inthe example shown, one or more pedals 1910, such as in FIG. 16A areprovided. However, as noted above, devices with a greater degree offreedom can be used. Optionally, gait training mechanisms, for exampleas described in U.S. provisional application No. 60/633,428 filed onDec. 7, 2004, also being filed as PCT application on same date as thepresent application and by the same applicant, entitled “GaitRehabilitation Methods and Apparatuses” and having attorney docketnumber 414/04391, the disclosures of which are incorporated herein byreference, are used. Optionally, such mechanism includes a support whichattaches to an ankle and can rotate and/or translate the ankle (e.g.,foot) in various (e.g., 2, 3, 4, or more) directions so as torehabilitate walking. Optionally, one or more mechanism modules areprovided for training hip motion, even while sitting. Optionally, atread-mill or training bicycle is provided for the patient to walk onwhile exercising his upper body. Motion of the treadmill is optionallysynchronized to rehabilitation exercises and actual performance by thepatient. Optionally, gait training includes individual training ofdifferent parts of the body and then training them together for acomplete (or partial) gait.

Optionally, device 1900 is used with a wheelchair and not a standardchair.

Docking System

FIG. 19B shows a docking station 1920 and FIG. 19C shows docking station1920 occupied by a wheelchair 1922. By docking station is meant astructure to which a patient can be brought and locked into place andthen rehabilitated. From a functional point of view it is generallydesirable that only a minimum of manipulation of the patient be requiredfor rehabilitation work to start. Thus, for example, the patient canstay in the wheelchair and optionally instead of adjusting the patient'sposition (e.g., initially and when exercises change) the rehabilitationdevice moves, optionally autonomously, to ensure correct relativepositioning.

In the embodiment shown, two varying orientation modules 1924 and 1926are provided on a track 1928. Optionally, the modules are moved by hand.Alternatively, motors (not shown) change the configuration of themodules and/or move them along track 1928. Track 1928 optionallyprovides power and/or data to the modules. Also non-varying orientationmodules or other rehabilitation devices may be attached.

An optional wheel-chair holding mechanism 1932 is shown positioned on atrack 1930. Optionally, the position is changed manually. Alternatively,the position is changed using a motor (not shown). Similarly, thewheelchair-engaging mechanism can be manual or motorized.

A set of foot pedals 1934 is shown, but it could be replaced by otherfoot-training devices.

An optional elbow support 1936 is shown, attached to a joint 1938.Optionally, elbow support 1936 is floating with respect to the person,optionally adjusted to compensate for the weight of the patient.Optionally, the floating is in a plane, for example in a plane parallelto the floor. Optionally the location of the elbow is measured by thesupport and can be used for various feedbacks such as measurement ofquality of motion. Support 1936 is optionally on a telescoping and/orarticulating arm, for example as described in FIG. 16.

A display 1940 is optionally provided, for example for use of atherapist and/or the patient. An input system 1942, for example akeyboard and a joystick may be provided as well. Optionally, the inputand output devices 1940 and 1942 can be swiveled to different positions,so that the therapist can access them while docking station 1920 isoccupied.

Display 1940, input 1942 and/or joint 1938 are optionally mounted on acolumn, optionally a telescoping column. Optionally, a display 1946(audio and/or visual) dedicated to the patient is provided.

A similar docking station may be provided for a gurney, for example withfour motion mechanisms, one for each limb. Alternatively, as describedbelow, the rehabilitation device is made portable enough so that it maybe brought to a bed-ridden patient.

Mobility

A feature of some embodiments of the invention is that a rehabilitationdevice is provided which is mobile. There are various levels of mobilityand various embodiments of the invention, as described herein canachieve these levels.

In an exemplary embodiment of the invention, mobility of arehabilitation device is used to move the device within a ward orbetween hospital wards.

FIG. 19D shows mobile rehabilitation devices 1950 positioned near a bed1951, in accordance with an exemplary embodiment of the invention. Inthis embodiment of a mobile device, a motion mechanism 1952 is mountedon a rail 1958, for example a curved rail with a base 1960. Wheels,optionally lockable and/or extending legs (not shown) may be provided onbase 1960. Rail 1958 optionally includes one or more tracks 1962 (slotsshown) for adjusting the position of mechanism 1952. Two differentattachments are shown, 1954 for an arm and 1956, for a leg. Optionally,the wheels are used to move device 1950 into storage. Collapsibledevices were described above, for example in FIG. 17B.

FIG. 19E shows an alternative mobile rehabilitation device 1964, coupledto bed 1951, in accordance with an exemplary embodiment of theinvention. One or more attachment mechanism 1972 lock device 1964 to bed1951. Wheels are optionally provided. Device 1952 may be used, forexample for rehabilitation from above. In an exemplary embodiment of theinvention, device 1964 comprises a frame 1970 on a top part 1966 ofwhich a movement mechanism 1952 is mounted. Optionally, device 1952 canmove along the frame. A ball grip attachment 1968 is shown.

Mobility may also be useful in other settings, for example, at home orin a small clinic. Also, as noted above, a mobile rehabilitation devicemay be carried by a therapist on home-calls.

In an exemplary embodiment of the invention, rehabilitation is performedin water (or a steam bath), or with water supporting the patient and/orproviding heat and/or massage. FIG. 19F exemplifies the use of mobilerehabilitation devices 1972 in a bathtub 1976, in accordance with anexemplary embodiment of the invention. A wheeled base 1978 is shown, butother base types, including a fixed base, may be used. In the embodimentshown, two arm attachments 1974 with extended connections are used andthe patient may be sitting or lying down.

Rehabilitation may also be carried out in a swimming pool, with device1972, for example, being attached to a ceiling above the pool.

In an exemplary embodiment of the invention, the rehabilitation deviceis kept outside the water, but attachments are made waterproof.Optionally, the device itself is made waterproof or at leastsplatter-proof. Optionally, the rehabilitation device is made batteryoperated, to prevent electric-shock hazard. Alternatively, pneumatic orhydraulic motors are used instead of electric motors. Optionally,low-voltage (e.g., 24, 12, 5 volts or less) are used to power therehabilitation device. Optionally a device without motors that includesbrakes, is used

In an exemplary embodiment of the invention, the mobility of therehabilitation device is used for rehabilitation in the outdoors, forexample in a person's garden (e.g., on grass) or in nature. In oneexample, a rehabilitation device is used for a recreational activitysuch as barbequing. The device can be used to help guide, diagnoses andtrain a patient in flipping hamburgers, for example. Optionally, largewheels are provided for better traveling over soft surfaces. In anotherexample, the rehabilitation device is used to rehabilitate outdooractivities such as golf or fishing. Optionally, special attachments areprovided for such activates, to match the range of motion of themovement mechanism used to the activity. In a fishing example, therehabilitation device can assist for example in holding a fishing rod,generating range of motion in the shoulder to through a fly and inresisting the pull of a fish (which is a varying force). Exemplaryattachments are an attachment to a fishing rod and an attachment to atip of the rod (e.g., simulating a fish).

In an exemplary embodiment of the invention, a leveling mechanism isprovided for uneven surfaces. This mechanism, for example, similar tothat of FIG. 17A includes an inclination sensor which detects the levelplane and adjusts the motion mechanism to be arranged suitably.

In an exemplary embodiment of the invention, a tip and or tilt detectionmechanism is provided. Optionally, when tipping is detected (e.g.,acceleration of the base of a rehabilitation unit), the unit generates awarning signal. Optionally, any attachments to the patient are released,to prevent damage to the patient. Optionally, the base includescollapsible sections so that if tipping is detected, the base cancollapse one section thereof and cause the device to fall away from thepatient.

In an exemplary embodiment of the invention, a mobile rehabilitationsystem for use out side of a sterile environment is made easier to cleanand/or proof against spills, dirt and some weather conditions.Optionally, the electronics and motion mechanisms are sealed.Optionally, joints are covered with flexible rubber so that fewer bumpsand cracks are present. Optionally, a wipe-clean plastic covering isprovided on the device.

In an exemplary embodiment of the invention, the rehabilitation systemis mounted on a wheelchair, for example on its side or in back, or in acar, for example, in the seat near a driver. Optionally, the device canbe fitted in the back of a van and the van is configured to be used as amobile rehabilitation unit, where a patient can enter (possibly in awheel chair, possibly using a lift) and exercise.

Modularity

In an exemplary embodiment of the invention, a rehabilitation deviceoptionally features modular design. Such modular design may manifestitself in one or more of the following manners:

(a) The device is capable of being broken down into modules. Thisallows, for example, for maintenance by replacing a defective module.Alternatively or additionally, the mobility of a device is enhanced bythe ability to take it apart into components which can be quickly puttogether again by a layperson. In an exemplary embodiment of theinvention, no special tools are required for taking apart or for puttingtogether the device. Optionally, a simple screwdriver or turn wrench isused. Optionally, the device can be broken down/folded up or put backtogether in less than 1 hour. Optionally, the time required is less than30 minutes, less than 20 minutes or less than 10 minutes, 5 minutes or 2minutes, for example.

(b) The device itself is a module. As can be seen for example in FIG.19, a same motion mechanism module can be used for multiple differentrehabilitation configurations. Optionally the unit as shown in FIG. 17is used as an attachable/detachable module for the docking station ofFIG. 19B.

(c) Modular attachments. As shown for example in FIGS. 16-19, varioustypes of attachments can be added to a same basic device, therebychanging its usage. In a particular example, the device is adapted forvarious patient sizes, for example children with Cerebral Palsy, byreplacing parts, for example an arm 102, with suitably sized parts.

In some embodiments of the invention the hand attachment includesmechanical and electrical quick connections. The mechanical quickconnect may include a pin that fits to a hole with locking theelectrical quick connect can includes spring loaded needles on one sideand surface pads on the others. A same set of connectors may be used formultiple attachments.

(d) Modular software. Optionally, the software used by therehabilitation device is provided as modular software, for example,separate modules for different attachments; modules which includes setsof exercises; separate modules for different motion modes; and/orseparate modules for different uses of the device (e.g., group, home orclinic).

Daily Life

As noted above, in an exemplary embodiment of the invention, arehabilitation device is used to help specifically rehabilitate apatient to achieve daily activities, such as opening doors, eating at atable, reading a book, getting dressed, brushing teeth and washingdishes.

FIG. 19G shows a rehabilitation device 1980 configured for use for dailyactivities, in accordance with an exemplary embodiment of the invention.A rehabilitation module 1952 is mounted upside down over a table 1986set with various eating utensils. An elbow rest 1984 is optionallyprovided. In this embodiment table 1986 is attached to a frame 1988which supports mechanism 1952. Alternatively, frame 1988 may be wideenough to surround an existing table or other home element.

In use, a hand of the patient is strapped to a movable tip 1982 ofdevice 1980 and the user attempts to or is guided through a dailyactivity such as picking up a fork. Optionally, a glove withforce-feedback is used to selectively rehabilitate individual fingers.Such gloves are known in the art.

In an exemplary embodiment of the invention, device 1980 is used for oneor more of training a patient to do activities related to daily life,testing the patient's current ability to do such activities and/ormonitoring a patient's ability. Optionally, such testing and/ormonitoring are used by insurance companies to decide on compensation orassistance required. Such testing can be repeated over a period of timeso that attempts to cheat may be detected by sudden spikes in ability.

It is noted that a very important goal for rehabilitation is quality oflife, which is optionally addressed and/or determined by training andtesting the ability to perform various daily activities.

In an exemplary embodiment of the invention, specific attachments areprovided for daily activities training. In one example, a spillageindicating cup is provided, which includes an inclination sensor. Inanother example, a whiteboard with ability to detect a pen position isused in rehabilitation exercises involving writing on a wall. Thedetected position and/or pressure is reported to the rehabilitationdevice which optionally holds, supports and/or guides the hand of apatient.

In an exemplary embodiment of the invention, an implement of dailyliving is turned into an attachment by providing one or more patches,for example stickers which include a sensors, for example a position ora pressure sensors, and attaching the patch to a daily use implement,such as hammer or a wall. The rehabilitation device optionally includesa position determining means, for example, a wireless unit whichcommunicates with position sensors on the patches or a camera whichimages the patches, so that the rehabilitation device can determinerelative positions and/or orientations of the daily use objects. In somecases, rehabilitation and/or diagnosis is carried out using the methodsdescribed herein but without mechanical support or kinesthetic feedback.Optionally, vibration or other feedback is provided to a patient byattaching a vibrating patch (under control of the rehabilitation device)to a limb which is being rehabilitated.

U.S. provisional application No. 60/566,079 filed on Apr. 29, 2004, alsobeing filed as PCT application on same date as the present applicationand by the same applicant, entitled “Fine Motor Control Rehabilitation”and having attorney docket number 414/04401, the disclosures of which isincorporated herein by reference describes various structures useful forrehabilitation of fine motor control or the combination of fine andgross-motor control.

FIG. 19H shows a device 1990 for assisting in training for activities ofdaily living, in accordance with an exemplary embodiment of theinvention. Rather than provide an entire table, device 1990 includes twosettable points 1992 and 1993 connected to a base 1994. A pair ofadjustable arms, for example goose-neck arms 1996 can be used to adjusttheir position in space. In use, for example for pouring tea, set points1992 and 1993 are positioned to emulate a situation, for example pouringtea. In an exemplary exercise, a patient is required to move a cup(e.g., helped by a rehabilitation device, not shown) from point 1992 topoint 1993. the trajectory is then evaluated. Set point 1993 is shown asa flat surface, on which items may be placed. Other structures andattachments, such as hooks, may be used. Optionally, set points 1992 and1993 (more may be provided) include sensors, for example proximitysensors (to detect human or rehabilitation robot), contact sensors,pressure sensors and/or position sensors. The set points may alsoprovide feedback, for example, lights, sound or vibration.

The relative positions of points 1992 and 1993 may be determined, forexample, using position sensors or cameras. Alternatively, tip 108 isused to register their position to the rehabilitation device, bycontacting points 1992 and 1993 in turn by tip 108. Optionally, a dummyarm is mounted on the rehabilitation device to calibrate the relativeexpected position of tip 108 and a set point, when the set point isactually being touched by a part of the user, such as a finger.

Small Chuck

In an exemplary embodiment of the invention, a joint in an articulatedarm is configured to provide selective and/or directional resistance.

FIG. 20 is a cross-sectional view of such a joint between a rod 2004 anda rod 2002. A chuck 2006 fits into a flaring end 2008 of rod 2004 andengages a ball 2012 attached to rod 2002. If chuck 2006 is retractedtowards rod 2004, it tightens around ball 2012 and increases theresistance thereof.

Optionally, one or more strain sensors and/or optical sensors isprovided between chuck 2006 and ball 2012, so that a direction of forcebeing applied to joint 2000, can be determined. Optionally, one or moreelectrically activated brake elements are provided, for examplepiezoelectric elements, which can selectively modify a degree ofresistance. This may be provided instead of or additional to aretracting chuck mechanism.

Balanced Gimbal Device

FIG. 21 shows an alternative rehabilitation device 2100, in which a balljoint is not used. An arm 2102, optionally extendible is optionallybalanced by an optional counter-weight 2110 around an axle 2106.Counter-weight 2110 may include a motor or variable brake forcontrolling extension of arm 2102.

A motor 2108 is optionally provided to rotate arm 2102 around axle 2106.A second hinge 2112 is provided to allow rotation around an axisperpendicular to arm 2102 and axle 2106. Optionally, motor 2108 includesa weight so that it balances arm 2102 relative to hinge 2112. Optionallya slot 2114 is provided in a base section 2104 of device 2100, forfunctioning as plate 1020 and slot 1030 above. A similar structuralarrangement may be used as well. Optionally, a rotatable plate 2116 isprovided for carrying slot 2114. A motor (not shown) is optionallyprovided for rotation around joint 2112. Optionally, joint 2112 israised to have an axis crossing the axis of axle 2106.

Alternative Gimbaled Device

FIG. 22A shows an alternative gimbaled device 2200 for use as a motionmechanism in accordance with an exemplary embodiment of the invention.FIG. 22B, described below shows a configuration of device 2200 includingmotors and/or brakes.

Device 2200 includes a gimbaled section 2202, an optionally removablez-axis element 2204 and an optionally replaceable handle 2206 attachedthereto. A modular connector 2208, for example as shown in FIG. 15 maybe used. Optionally, a release pin 2210 is user to selectively take offz-axis element 2204, for example, for replacement or for storage.

Gimbaled section 2202 optionally includes a frame 2212 including a firsthinge 2214. Optionally, a guiding frame 2216 is attached to hinge 2214that provides a first stationary axis and includes a guide pathway forguiding an extension (or cam follower or pin) 2218 (described below).

A second stationary axis is provided by a hinge 2220 also on frame 2212.In an exemplary embodiment of the invention, handle 2204 is optionallyrigidly attached to a frame 2222 which includes extension 2218. Thus,the spherical rotation motion of handle 2204 is translated to rotationof the two hinges around the stationary axes. Optionally, extension 2218includes a balancing weight (not shown).

FIG. 22B shows device 2200 in an exemplary deployed configuration, withtwo braking mechanisms 2232 and two force control mechanism 2230attached. As can be appreciated a practical device can be constructedwith only one of resistance and force control. Force control mechanisms2230 are described below in greater detail.

Referring to braking mechanism 2232, in an exemplary embodiment of theinvention, a disc braking mechanism is used in which a disc (or part ofa disc) 2240 is selectively constrained by a friction element (notshown). A motor 2250 selectively sets the pressure applied by thefriction element on the disc. Other friction mechanisms may be providedas well. In an exemplary embodiment of the invention, the followingmechanism is used to couple motor 2250 to disc 2240. A coupling 2248converts rotational motion of motor 2250 into axial motion of a rod2247. Optionally, rod 2247 is spring-loaded so that absent power tomotor 2250, the pin moves to a locked or an unlocked position, where thefriction on disc 2240 is maximal or minimal (depending on theimplementation). A rest 2246 is thereby selectively lifted or pusheddown by rod 2247. The friction element, while not shown, is coupled to arotatable element 2242 that converts rotation thereof to motion of thefriction element towards or away from disc 2240. Optionally, element2242 is a screw. Element 2242 includes an trans-axial lever 2244 whichis engaged by rest 2246 and thereby rotates element 2242 when rest 2246is moved. Rotatable element 2242 is optionally spring-loaded.

Other brake mechanisms can be used, for example as known in the art ofbrakes, for example, electrical, fluid, magnetic and/or mechanicalbrakes.

In an alternative embodiment of the invention, coupling between motionin the various axis is reduced by providing a single uni-directionalbrake. In an exemplary embodiment of the invention, the brake comprisesa spherical segment which is selectively pressed against pin 2218.

Also shown in FIG. 22B are various optional sensors. A sensor 2234 iscoupled to the axis of hinge 2220 and report when handle 2204 is rotatedto its limit(s). A sensor 2236 reports when the handle is in a reference(or home) position. A sensor 2238, for example a rotatary potentiometeror encoder reports on the angle of rotation of hinge 2220. Similarsensors may be used for the hinge 2214.

In some embodiments of the invention, the brake mechanism is used forone or more of providing safety by stopping motion, providingprogrammable resistance (even in a system without active motion of thedevice) and/or balancing (e.g., by providing friction when needed tocounteract external forces). Optionally, the braking action in the twomodules 2232 is coupled to provide for uniform braking behaviorindependent of whether the motion of handle 2204 is along one of thestationary axes or not.

Cantilevered Gimbaled Mechanism

FIG. 23 shows a cantilevered gimbaled mechanism 2300 in accordance withan exemplary embodiment of the invention. A frame 2302 is coupled(rigidly or not, as will be described in FIG. 25) to a handle (notshown) which is optionally attachable to a drive system 2304 (e.g., forselectable extension and resistance to axial motion of the handle).Frame 2302 is rotatably coupled to a frame 2306. In an exemplaryembodiment of the invention, relative rotation between frames 2302 and2306 is provided by a motor 2316. In an exemplary embodiment of theinvention, motor 2316 couples the frames using a worm gear 2314 andpinion 2312. Other connections methods may be provided. Optionally, theworm gear has a lead angle small enough to prevent motion of the handlefrom back-driving the motor. Possibly a worm gear is cheaper, quieterand/or allows a lower cost motor to be used, as compared to using aprecise motor and/or gear-box.

Frame 2306 is optionally coupled to a base bracket 2307 using a similarmechanism, of which only pinion 2308 and worm 2310 are shown.

Optionally, braking is provided as described in the previous embodiment.

Force Control Mechanism

FIG. 24A shows a force and drive control mechanism 2400, in accordancewith an exemplary embodiment of the invention. As shown, mechanism 2400includes a drive section and a force feedback section. One or both ofthese sections may be omitted in some embodiments.

Referring first to the drive section, an axle (not shown) of hinge 2220or 2214 is coupled to an inner pinion section 2402 of a pinion 2404, forexample via a gear section formed on the axle. Optionally, otherattachment methods, for example direct attachment, are used. Pinion 2404is rotated by a worm gear 2406 which turns on an axis 2407. In anexemplary embodiment of the invention, power is provided by a motor 2414via a set of two pulleys 2408 and 2410 connected by a belt 2412. Otherpower trains may be used as well.

Referring to the force feedback section, in an exemplary embodiment ofthe invention, worm gear 2406 has a lead angle small enough so that itcannot be back-driven by pinion 2404. Instead, force (e.g., from thehandle) which counteracts the force applied by motor 2414 will causeworm gear 2406 to move axially along axis 2407. Optionally, one or bothof a viscous braking mechanism and a resilient resistance mechanism areprovided to counteract this force. Various combinations of settings maybe provided, for example resulting in what is shown in FIG. 3B.

Axial movement of worm gear 2406 results in displacement of one of thetwo levers marked 2422 (the figure shows a mirror-imaged mechanism).Viscous cushioning is optionally provided by a cushion 2440 resistingmotion of lever 2422. Cushion 2440 is optionally adjustable, for exampleby hand or by the rehabilitation device. A linear potentiometer or otherposition sensor, are optionally used to detect the offset of worm gear2406.

In an exemplary embodiment of the invention, a spring 2420 resists themotion of lever 2422. Optionally, spring 2420 can be selectablypreloaded by a motor 2424. In the embodiment shown, a set of pulleys2426 and 2430 and a belt 2428 cause the rotation of a threaded shaft2432. In an exemplary embodiment of the invention, a nut 2434 (or othermechanism) rides on the screw and converts its rotation into preload ofspring 2420. Optionally, shaft 2432 is threaded in opposite directionson its two ends. It should be appreciated that separate preloading foreach of the two springs 2420 may be provided, for example if anasymmetric force resistance is desired, or to counter-balance forgravity. Optionally, manual adjustment of preloading is provided by anut 2438, possibly used for initial calibration and setting.

Optionally, a pin 2436 is provided to limit the axial extent of motionof worm gear 2406. It should be noted that if the preload is above zero,axial motion of worm gear 2406 will not occur until this force isovercome. This corresponds to F_(min) in FIG. 3B. Optionally, the forcemechanism is set up so that there is more resistance to extending motion(away from the body) than to motion towards the body.

Other mechanical structures can be provided as well, for example,springs 2420 can sit on axis 2407. In another example, instead of motor2424 and the associated pre-load setting mechanism can be replaced by asingle spring coupled between the two levers 2422.

This structure can provide various modes of operation for example:

a) User passive mode. In this mode, motor 2414 drives worm gear 2406 andworm gear 2406 rotates pinion gear 2404 that is connect to the handle.

b) Free user mode. In this mode, a user moves the handle in any userdetermined direction and the system follows the user. In thisembodiment, mechanism 2400 acts as a mechanical diode is used todecouple the user motion from the motor. As the user exerts force on therobot arm, worm gear 2406 moves axially as described above. This linearmotion is measured and can be used as input to a controller. The amountof force felt by the user is generally determined by the preload ofspring 2420. The preload can be set or as in this case be controlled bythe motorized preload motor.

In the free user mode the controller receives the input from the linearpotentiometer and instructs motor 2424 to follow in the same direction.This causes the user to a predetermined force counteracting his desiredmotion.

c) Restricted mode (force field). An additional use for the spring motorcombination is to create a track where the counteracting force isminimal but any deviation from the track will result in higher springdisplacement and thus a force opposite the deviation (e.g., as shown inFIG. 3A). Optionally, this mode is activated for a particular speed,thereby setting up an isokinetic exercise.

d) Initiated Mode. A user starts a motion in a certain direction, whichwill be sensed as displacement of worm gear 2406. This motion can thenbe carried to completion by the rehabilitation device. Optionally, themotion will be completed only if the initiated move was in apredetermined direction.

e) Assist mode. When a motion is in progress, spring 2420 is preloadedin a fashion which pushes the handle in the direction of the motion(e.g., positive feedback). This may be a continuous force or it may beprovided in pulses.

f) Static. Optionally, the force mechanism is used to require a patientto apply a force at a point in space without substantial movement of thehandle. The force can be measured and/or controlled on the fly. Itshould be noted that a spring mechanism can generally provide morerealistic small motions in response to force than a friction mechanismor direct robotic motion using motors.

A potential advantage of the spring-motor combination is that velocityand/or range limitations on motion can be provided. Another potentialadvantage is that gradual (e.g., resilient) stopping can be provided,even in an emergency stop. Another potential advantage is that theviscous damping can provide a dynamic feeling.

FIG. 24B is a flowchart 2460 of the operation of mechanism 2400 when twosuch mechanisms are attached to the device of FIG. 22B, in a free-handmode, in accordance with an exemplary embodiment of the invention. Asimilar process may be used for implementation with force control inthree axes.

Flowchart 2460 describes how the magnitude and direction of forceapplied by a user is measured and then used to guide the motion of thehandle. Acts 2462 through 2476 are described only for Phi, but arecarried out for all axes (e.g., Theta), as well.

At 2462, measurement of the Phi offset is acquired.

At 2464 optional filtering is applied, for example low pass filteringwhich smoothes the signal and/or removes noise.

At 2466, a scaling operation is optionally performed, for example tomatch calibration and control parameters.

At 2468, a noise gate is optionally applies where signals below athreshold are converted to zero.

At 2470, the magnitude and/or direction of the change in position areoptionally extracted.

At 2472, a position command is optionally generated using a gain factor.

At 2474, the position command is optionally clamped to be at least aminimal value, for example, to overcome friction and/or noise levels.

At 2476, an absolute position command is optionally generated.

At 2478, the velocities of Phi and Theta axes are calculated.Optionally, acceleration is calculated as well.

At 2480, a composite vector of correction is found. Optionally, thecomposite vector is a maximum of phi and theta rather than a vectorcombination, this may serve to stabilize the system and/or preventmechanical problems.

At 2482, a gain smaller than 1 is optionally applied, possiblyincreasing the stability.

At 2484, the angle of the velocity vector is optionally calculated.

At 2486, the components for Phi and Theta velocity are calculated.

At 2488, a command for the motive source (e.g., motors) is generated.

Coupled Force Control Mechanism

FIG. 25 shows an alternative force control mechanism 2500 in which Phiand Theta axes are coupled using a single spring mechanism. A handle2502 is moved using axes not shown. In one example, mechanism 2500comprises an inner mechanism of the embodiment described in FIG. 23(where external Phi and Theta axes are shown).

An axis 2504 (and a matching orthogonal axis, not shown) comprise innerPhi and Theta axes which handle 2502 rotates around a small amount whenforce control is applied. A bottom part 2506 contacts a plate 2508. Thesmall amount of rotation causes plate 2508 to be depressed by part 2506(other shapes may be provided, but part 2506 is optionally rounded atits circumference). This depression is resisted by one or more springs2510, for example four springs. The pre-load of the springs may be setusing a motor 2522 which using a driver train comprising pulleys 2520and 2516 and a belt 2518 can rotate a screw 2514 which compressessprings 2510 by lifting a base 2512. Alternatively or additionally,manual pre-loading may be practiced.

Optionally, linear motion of plate 2508 is ensured using a bushing 2524or other means as known in the art. A mechanical stop may be provided tothe relative motion of cap 2508 and base 2512, so that sufficientpreload of springs 2510 prevents any mechanical motion.

The rounding of the edges of part 2506 may be calculated to ensure alinear relationship between angle of rotation and displacement.

The axes of inner rotation may be congruent with the axes of externalrotation, however, this is not required. For example, the axes may notbe co-planar and/or the axes may not be parallel.

Various measurement means may be provided, for example, a linearpotentiometer measuring spring displacement and/or rotary potentiometersmeasuring Phi and Theta rotation. Measured values may be used with theflowchart of FIG. 24B.

Optionally, spring 2510 is used to also provide compliance in theZ-direction. In one example, when handle 2502 is depressed, spring 2510provides resistance. The hinge at axis 2504 is optionally placed in aslot is that z-axial motion of the hinge is possible.

Z-Axis Motion Mechanism

FIGS. 26A and 26B shows a z-axis motion and force response mechanism2600, in accordance with an exemplary embodiment of the invention. Themechanism comprises a three part telescoping rod comprising a centralportion 2604, a top portion 2608 and a bottom portion 2606. An externalmotor (e.g. 2304 from FIG. 23) couples to a coupling 2602 and therebyrotates a rod 2609. The use of an external motor optionally helpsmodularity as a z-axis mechanism can be made lower cost andinterchangeable with other z-axis mechanisms. A coupling 2610, forexample a nut converts the rotary motion into axial motion of centralportion 2604. The telescoping of portions 2604, 2606 and 2608 isoptionally guided by a pair of linear bearings, 2614 for portion 2608and 2612 for portion 2606. The linear bearings lie in channels 2613 and2611, respectively.

In an exemplary embodiment of the invention, a combined rack and pinionand timing belt mechanism is used to synchronize the extension ofportions 2606 and 2608, as follows. Each of the channels 2611 and 2613also includes a rack defined thereon and portion 2604 includes twopinions 2616 and 2618, one on either end. When portion 2604 extends,rack 2611 causes pinion 2616 to rotate. A timing belt 2620 which isconnected between pinions 2616 and 2618 (on co-axially coupled beltpulleys of same effective diameter) causes pinion 2618 to rotate insynchronization. Pinion 2618 then moves rack 2613, causing telescopingof portion 2608.

In an exemplary embodiment of the invention, telescoping allows thez-axis mechanism to be compact and assist in portability. Also, itallows motions near to the center of rotation of the motion mechanism.In an exemplary embodiment of the invention, telescoping allows a rangeof 2:1 or close to 3:1 of z-axis length. Additional telescoping portionscan be provided for a greater extension ratio.

Referring to the upper part of the z-axis mechanism, an exchangeablehandle 2630 is shown. Axial motion of handle 2630 is optionally shown bymotion of a linear measurement potentiometer 2638. Optionally, handle2630 is attached using a quick connect mechanism.

In an exemplary embodiment of the invention, a spring 2632 providesresilient resistance to axial motion of handle 2630, for example usingthe logic as described above in FIG. 24.

Referring to FIG. 26B, spring 2632 is a spiral spring, whose resistancecan be changed by changing its effective length, for example by moving asliding stop 2636 which determines a length of the leaves of spring2632. This sliding stop is optionally moved manually, for example byrotating a housing 2634. Alternatively, an internal motor may beprovided. This change in leaf length is generally comparable to a changein preload. Minimal force setting may be provided by actually preloadingspring 2636, for example by axial motion thereof, or by providinganother spring to resist axial motion. Preload may also be achieved byrotating spring 2632 itself, thereby tensing the spring.

The range of motion of the force control mechanisms can be, for example,3 cm, 5 cm, 10 cm, 15 cm, 20 cm or intermediate, smaller or greaterranges, depending on the implementation.

It should be noted that in some embodiments of the invention the use ofgear-reduction ratios allows lower power and/or lower cost motors to beused.

It should be noted that force in the Z-axis can be transferred using aflexible or a bent coupling. Thus, for example, the z-axis element canbe a 90 degree elbow in which only the far portion extends.Alternatively or additionally, goose-neck like mechanism is used todefine shape in space for the z-axis element.

Games

Various games have been mentioned. In an exemplary embodiment of theinvention, one or more of the following game-types is provided: roleplaying games (adventure and D&D games), kinetic games (shoot-em-up),board games and simulation games (e.g., soccer and tennis).

Games may be played, for example, one-on-one, against a human opponentor against a machine opponents.

In an exemplary embodiment of the invention, device 100 serves as aninput device, for example replacing a joystick. Alternatively oradditionally, device 100 is used as a VR input device, for example toread limb positions. Alternatively or additionally, specialized inputmodes may be defined, for example, spatial positions of arm 102 may bemapped to virtual positions on the screen or in the game world, or tovelocities and/or accelerations thereof. Gestures may be defined forvarious controls, for example, “fire”, “lift” and “put” commands mayeach have an associated gesture.

In an exemplary embodiment of the invention, child games are provided,for example for encouraging paretic or CP children to avoid neglectingbody parts. Device 100 may also be used as a social focal point forpreventing the paretic child from becoming an outcast.

In an exemplary embodiment of the invention, a game is fitted to theability of the patient, for example, limiting the ROM required,providing enhancement of patient motion, changing the game speed andchanging the visual field which needs to be attended.

In an exemplary embodiment of the invention, the game is selected tomatch a motivation level of the patient, for example, a simple gameselected for low-motivation patients.

Safety

In an exemplary embodiment of the invention, one or more safety featuresare provided to prevent injury to a patient. For example, one or more ofthe following safety mechanism may be used:

a) Dead man switch. If a patient releases this switch (or touches asuitable button) movement of device 100 is frozen and/or all forces andresistance brought to zero. Other “safe harbor” configurations can bedefined instead.

b) Tearing pin. A pin may be used to attach tip 1008 (or otherattachment) to arm 1002. If a certain threshold force is exceeded, thepin tears and the attachment is released from the arm. Different pinswith different tearing thresholds may be selected for differentsituations. Optionally a wire can be attached to the pin for feedback.Optionally the pin comprises two magnetically attracted materials, withthe degree of attraction optionally set by electrical current.

c) Locking. Arm 1002 may have an initial locking condition, to allow apatient to lean on it.

d) Voice activation. Voice activation and/or deactivation may beprovided, to allow a patient to shout the system to a stop.

e) Analysis. Optionally, the actual movements and/or forces applied by apatient are analyzed to determine if a threshold is being approached orif the patient is experiencing undue stress.

f) Resiliency. The force control mechanism with a spring prevents suddenstops from suddenly stopping the patient. Instead, the spring allowssome compliance and a more gradual stop.

g) Force-measured. If the force mechanism determines a force and/orspatial divergence above a threshold, the motion can be stopped andoptionally moved opposite to the direction of force application.

Balance Training

In an exemplary embodiment of the invention, a rehabilitation module isused for balance training. In one example, a seat is attached to tip1008 and a patient sits on the seat. A non-rotating plate 1020 with aslot sets the direction in which the seat is allowed to roll and theresistance level sets the difficulty. Optionally, a handle bar isprovided. Alternatively or additionally, a foot rest and/or pedals areprovided for the feet. Alternatively one or more rehabilitation modulesfor the arms are provided. In this manner, various daily and sportsactivities can be simulated and trained for. Optionally, a virtualreality type display or a television display are provided to enhance thesense of reality. Such a virtual reality display may be provided inother embodiments of the invention, for example to show feedback, toshow instructions or to make the activity more interesting.

U.S. provisional application No. 60/633,442 filed on Dec. 7, 2004, alsobeing filed as PCT application on same date as the present applicationand by the same applicant, entitled “Methods and Apparatuses forRehabilitation Exercise and Training” and having attorney docket number414/04388, the disclosures of which are incorporated herein byreference, describes training of balance, for example, using such achair. Optionally, a full body system is used to train multiple bodyparts associated with balance simultaneously, for example, torso, armsand/or legs.

In an exemplary embodiment of the invention, device 100 is used to trainbalance while standing. For example, a patient performing a reachingexercise to arm 102, when tip 108 is at various spatial positions; somepositions requiring only arm extending and some positions requiringtorso bending.

Multi-Modal Therapy and Coordination Training

In an exemplary embodiment of the invention, device 100 can be used forproviding rehabilitation in modes other than motor. In one example, thedisplays (audio and/or visual) are used to perform visual and/orauditory rehabilitation. Thus, a single device can be used for multiplerehabilitation types (e.g., at home) and serve as a single point ofcontact both for the patient and for the therapist. If multipletherapists exist, the device can serve to coordinate between the varioustherapies and/or track general parameters, such as general progress,motivation and/or cognitive level. In an exemplary embodiment of theinvention, device 100 selectively applies an exercise in one of severalmodalities, for example, for load balancing and/or for interest.

In an exemplary embodiment of the invention, device 100 is used torehabilitate the coordination between modalities and/or using therehabilitation of one modality to help rehabilitate other modalities.One example is eye-hand coordination, where a patient is shown a targeton a screen and the aim is to move tip 108 to tack it. Another exampleis timing where a patient needs to provide a command at a certaintiming, possibly in an auditory modality. Another example is spatialplanning, where a patient is provided with verbal instructions ofgradually increasing complexity with regard to spatial motions.

In an exemplary embodiment of the invention, progressively more complexvisual instructions, motor acts and feedback (visual or not) areprovided to the patient. Similarly, progressively more complex audio,kinesthetic, haptic, and smell (using scent release attachments)feedback and/or instructions are provided.

In a particular example, speech recognition is rehabilitated in concertwith motion for example requiring speech to be understood fast enough toperform the motion in time, or respond to verbal instructions. A usermay be required to provide speech utterances which match his motions. Aspeech recognition module may be provided.

In another example, visual stimuli is made more complex as visualrehabilitation progresses, for example, starting with a light, then alight at a position, then a speed of blinking, then text which must beread, all of which are used to prompt motor action or serve as feedback(e.g., for progressively complex motor tasks: moving arm, moving to adirection, moving to a particular area).

A particular advantage of some embodiments of device 100 is mechanicalfeedback and support is provided to the patient. In some embodiments,some of the methods described herein for motor rehabilitation (and whichmay find special utility therefor) are used for non-motorrehabilitation, for example, measuring motivation, remoterehabilitation, group activities and support by a computer of useractivities (for example for group participation).

Other Devices

Various designs for robots and positioning devices (e.g., hexapods) areknown in the art. It should be appreciated that various ones of thestatements described herein may be adapted for such robots and/orpositioning devices, in accordance with exemplary embodiments of theinvention. Alternatively or additionally, software may be provided forsuch robots and devices for carrying out various ones of the methodsdescribed herein, all in accordance with exemplary embodiments of theinvention.

U.S. provisional application No. 60/604,615 filed on Aug. 25, 2004, thedisclosure of which is incorporated herein by reference, describestaking the effects of brain plasticity into account. The methodsdescribed herein may use EEG or fMRI as an input for deciding, forexample, on feedback or type of device mode to use.

U.S. Provisional Application 60/566,078 filed on Apr. 29, 2004, alsobeing filed as PCT application on same date as the present applicationand by the same applicant, entitled “Neuromuscular Stimulation” andhaving attorney docket number 414/04400, the disclosures of bothapplications are incorporated herein by reference, describe stimulatinga paretic limb while moving the limb or otherwise supporting the motionof the limb. EMG measurements, for example of healthy limbs areoptionally used as part of the teaching of the present application fordeciding on stimulation and/or supported motion of a paretic limb.

It should be noted that the rehabilitation devices described herein areoptionally usable not only at a home but also at care centers, such asold age homes, hospitals and rehabilitation centers.

It will be appreciated that the above described methods ofrehabilitation may be varied in many ways, including, omitting or addingsteps, changing the order of steps and the types of devices used. Inaddition, a multiplicity of various features, both of method and ofdevices have been described. In some embodiments mainly methods aredescribed, however, also apparatus adapted for performing the methodsare considered to be within the scope of the invention. It should beappreciated that different features may be combined in different ways.In particular, not all the features shown above in a particularembodiment are necessary in every similar embodiment of the invention.Further, combinations of the above features are also considered to bewithin the scope of some embodiments of the invention. Also within thescope of the invention are kits which include sets of a device, one ormore tearing pins, one or more attachments and/or software. Also, withinthe scope is hardware, software and computer readable-media includingsuch software which is used for carrying out and/or guiding the stepsdescribed herein, such as control of arm position and providingfeedback. Section headings are provided for assistance in navigation andshould not be considered as necessarily limiting the contents of thesection. When used in the following claims, the terms “comprises”,“includes”, “have” and their conjugates mean “including but not limitedto”. It should also be noted that the device is suitable for both malesand female, with male pronouns being used for convenience.

It will be appreciated by a person skilled in the art that the presentinvention is not limited by what has thus far been described. Rather,the scope of the present invention is limited only by the followingclaims.

1. (canceled)
 2. A distributed rehabilitation system, comprising: atleast one rehabilitation device; at least one monitoring site remotelylocated from the at least one rehabilitation device in communicationwith the at least one rehabilitation device through a communicationsnetwork; and, a station at the at least one monitoring site, with atleast a display and a user input and configured for monitoring the atleast one rehabilitation device; wherein when there is onerehabilitation device in the system there is a plurality of monitoringsites and when there is a plurality of rehabilitation devices in thesystem there is at least one remote monitoring site.
 3. The distributedrehabilitation system of claim 2, wherein the at least onerehabilitation device is configured to be controllable by the stationthrough the communications network.
 4. The distributed rehabilitationsystem of claim 2, wherein the plurality of monitoring sites is dividedby a skill level of a monitoring health care provider.
 5. Thedistributed rehabilitation system of claim 2, wherein the station isconfigured for real-time monitoring of the at least one rehabilitationdevice.
 6. The distributed rehabilitation system of claim 2, wherein thestation is portable.
 7. The distributed rehabilitation system of claim2, further comprising a database storing patient data.
 8. Thedistributed rehabilitation system of claim 2, wherein the plurality ofrehabilitation devices are in communication with each other through thecommunications network.
 9. The distributed rehabilitation system ofclaim 8, wherein the plurality of rehabilitation devices are groupedinto at least one network based on at least one of: similar oroverlapping ailments; treatments; prognoses; and personal matching ofpatients using of the devices.
 10. The distributed rehabilitation systemof claim 8, wherein at least one of the plurality of rehabilitationdevices displays the progress of the user of at least one of the otherrehabilitation devices.
 11. The distributed rehabilitation system ofclaim 8, wherein each of the rehabilitation devices of the plurality ofrehabilitation devices is tasked with accomplishing a specific goalwhich forms a part of a group of collective goals of the plurality ofrehabilitation devices.
 12. The distributed rehabilitation system ofclaim 8, wherein one of the plurality of rehabilitation devices isdesignated by the system as a group leader for the other of theplurality of rehabilitation devices to follow.
 13. A rehabilitationdevice, comprising: a joint having freedom of motion in at least twodegrees of freedom, the joint including a first frame, and a secondframe, rotatably attached to the first frame at at least one sharedpivot point; an actuator, operationally coupled to the joint, thatincludes a movement mechanism capable of applying a force to the jointin at least two degrees of freedom of motion; a radial extensionattached to said joint and adapted for movement with a limb of a personat at least one point of the radial extension; and a controller adaptedto control motion of the joint and the actuator and thereby motion ofsaid radial extension.
 14. The rehabilitation device according to claim13, where the first frame is rotatably attached to the second frame byat least one hinge.
 15. The rehabilitation device according to claim 14,further comprising a guiding frame attached to the hinge, wherein theguiding frame includes a guide pathway for an extension configured toproject through the guide pathway.
 16. The rehabilitation deviceaccording to claim 13, further comprising a balancing weight.
 17. Therehabilitation device according to claim 13, further comprising a wormgear and pinion assembly coupling the actuator to the first frame andthe second frame.
 18. The rehabilitation device according to claim 17,wherein the worm gear is configured with a lead angle small enough toprevent motion of the radial extension from back-driving the actuator.19. The rehabilitation device according to claim 13, wherein the radialextension is configured to be at least one of removable and reversiblyextendible along a z-axis extending away from the joint.
 20. Therehabilitation device according to claim 19, further comprising areplaceable handle attached to the radial extension.
 21. Therehabilitation device according to claim 20, further comprising amodular connector configured to connect the replaceable handle to theradial extension.
 22. The rehabilitation device according to claim 20,further comprising a release pin configured to connect the replaceablehandle to the radial extension.
 23. The rehabilitation device accordingto claim 13, further comprising at least one braking mechanism and atleast one force control mechanism.
 24. The rehabilitation deviceaccording to claim 13, further comprising at least one rotational orpositional sensor.
 25. A method of using a rehabilitation device,comprising: moving a radial extension operatively connected to a jointhaving freedom of motion in at least two degrees of freedom, the jointincluding a first frame, and a second frame, rotatably attached to thefirst frame at at least one shared pivot point; wherein the moving isconducted by an actuator operationally coupled to the joint, theactuator including a movement mechanism capable of applying a force tothe joint in at least two degrees of freedom of motion.
 26. A method ofusing a rehabilitation device according to claim 25, further comprisingapplying selective resistance to the moving using at least one brakingmechanism.
 27. A method of using a rehabilitation device according toclaim 25, further comprising applying selective resistance to the movingfor balancing.